Predictors of lymph node metastases in patients with mucinous appendiceal adenocarcinoma. Issue 3 (28th April 2020)

• Record Type: Journal Article
• Authors: Shannon, Adrienne B.; Goldberg, Drew; Song, Yun; Paulson, Emily C.; Roses, Robert E.; Fraker, Douglas L.; Kelz, Rachel R.; Miura, John; Karakousis, Giorgos C.
• Is Part Of: Journal of surgical oncology. Volume 122:Issue 3(2020)
• Page Start: 399
• Page End: 406
• Publication Date: 2020-04-28
• Subjects: appendix cancer -- lymph node harvest -- lymph node metastases -- positive lymph nodes -- risk‐score model -- surgical oncology -- surgical outcomes; Cancer -- Surgery -- Periodicals; Neoplasms -- Periodicals; 616
• DOI: 10.1002/jso.25963
• Languages: English
• ISSNs: 0022-4790

Abstract

Abstract: Background: Lymph node metastasis (LN+) is a prognostic factor in appendiceal cancers, but predictors and outcomes for LN+ in mucinous appendiceal adenocarcinoma (MAC) remain poorly defined. Methods: Patients were identified from the 2010 to 2016 NCDB who underwent surgical resection as first‐line management for Stage I‐III mucinous appendiceal cancer. A LN+ risk‐score model was developed using multivariable regression on a training data set and internally validated using a testing data set. Three‐year overall survival (OS) was analyzed by Cox proportional hazards regression. Results: Of 1158 patients, LN+ (N = 244, 21.1%) patients were more likely to have higher pT group and grade of disease, lymphovascular invasion (LVI), and positive margins on univariate analyses. Predictive factors associated with LN+ on multivariable analysis included positive surgical margins (odds ratio [OR] 3.00, P <.0001), higher grade (moderately differentiated: OR, 2.16, P < .0001; poorly or undifferentiated: OR, 3.07, P < .0001), and LVI (OR, 7.28, P < .0001). A validated risk‐score model using these factors was developed with good performance (AUC 0.749). LN+ patients had a worse 3‐year OS compared with LN− patients (17.4% vs 82.6%, hazard ratio 1.96, P = .001). Conclusions: LN+ is associated with worse survival in patients with MAC. A risk‐score model using margin status, LVI, and grade can accurately risk stratify patients for LN+.