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Elevated prevalence of nodal positivity in carcinoid tumours of the appendix smaller than 2 cm has a negative impact on overall survival
Author(s) -
Skancke M.,
Sharp S. P.,
Maron D. J.,
Wexner S. D.
Publication year - 2020
Publication title -
colorectal disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.029
H-Index - 89
eISSN - 1463-1318
pISSN - 1462-8910
DOI - 10.1111/codi.15287
Subject(s) - medicine , appendix , occult , pathological , proportional hazards model , carcinoid tumour , hazard ratio , lymphovascular invasion , cancer , carcinoma , survival analysis , gastroenterology , pathology , metastasis , confidence interval , paleontology , alternative medicine , biology
Aim The current standard of care for clinically node‐negative carcinoid tumours of the appendix < 2.0 cm in size is appendectomy alone. The aim of this analysis was to evaluate the prevalence of pathological nodal positivity in clinically node‐negative appendiceal tumour specimens < 2.0 cm and quantify the impact of occult pathological nodal positivity on overall survival following resection. Method A retrospective database review of the 2019 US National Cancer Database for appendiceal cancer identified 2007 cases of clinically node‐negative appendiceal carcinoid tumours based on SEER histology codes 8240, 8241, 8242, 8243, 8243, 8244, 8245, 8246 and 8249. Kaplan–Meier with log‐rank testing and multivariate Cox regression analysis evaluated the impact of occult nodal positivity on overall survival following resection for clinically node‐negative appendiceal carcinoma. Results The prevalence of occult nodal positivity increased from 1.9% for sub‐centimetre tumours to 7% for tumours between 1.0 and 1.5 cm, 16.5% for tumours between 1.5 and 2.0 cm and to >29.5% for tumours > 2.0 cm. Rates of metastatic spread were similar for tumours < 2.0 cm but increased for larger tumours. Over two‐thirds of patients received a segmental colectomy as definitive surgical therapy. After controlling for differences in cohorts, multivariate analysis showed an increased hazard ratio for mortality of 162% (HR 2.62, CI 1.884–3.541) for patients with pathological node‐positive disease. Conclusion Clinically node‐negative carcinoid tumours of the appendix bigger than 1.5 cm have an increased rate of occult nodal spread which has a negative impact on overall survival.