Elevated prevalence of nodal positivity in carcinoid tumours of the appendix smaller than 2 cm has a negative impact on overall survival. (30th August 2020)

• Record Type: Journal Article
• Authors: Skancke, M.; Sharp, S. P.; Maron, D. J.; Wexner, S. D.
• Is Part Of: Colorectal disease. Volume 22:Number 12(2020)
• Page Start: 1958
• Page End: 1964
• Publication Date: 2020-08-30
• Subjects: Appendix -- carcinoid tumour -- nodal positivity; Colon (Anatomy) -- Diseases -- Periodicals; Rectum -- Diseases -- Periodicals; 616.34
• DOI: 10.1111/codi.15287
• Languages: English
• ISSNs: 1462-8910

Abstract

Abstract: 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.