Who should get a right colectomy in low-grade appendiceal adenocarcinomas? Association of lymphovascular invasion and nodal metastases.

Autor: Waheed MT; Department of Surgery, City of Hope National Medical Center, Duarte, CA. Electronic address: https://twitter.com/mtalhawaheed., Malik I; Department of Surgery, City of Hope National Medical Center, Duarte, CA., Blakely AM; Surgical Oncology Program, National Cancer Institute, National Institutes of Health, Bethesda, MD. Electronic address: https://twitter.com/AMBlakely., Zerhouni Y; Department of Surgery, City of Hope National Medical Center, Duarte, CA., Hanna M; Department of Surgery, City of Hope National Medical Center, Duarte, CA. Electronic address: https://twitter.com/DrMarkhhanna., Melstrom K; Department of Surgery, City of Hope National Medical Center, Duarte, CA. Electronic address: https://twitter.com/laleh_melstrom., Lai LL; Department of Surgery, City of Hope National Medical Center, Duarte, CA., Kaiser AM; Department of Surgery, City of Hope National Medical Center, Duarte, CA. Electronic address: https://twitter.com/AndreasMKaiser., Thinzar L; Department of Surgery, City of Hope National Medical Center, Duarte, CA. Electronic address: https://twitter.com/thinzarr., Paz IB; Department of Surgery, City of Hope National Medical Center, Duarte, CA., Raoof M; Department of Surgery, City of Hope National Medical Center, Duarte, CA. Electronic address: mraoof@coh.org.
Jazyk: angličtina
Zdroj: Surgery [Surgery] 2024 Sep; Vol. 176 (3), pp. 560-568. Date of Electronic Publication: 2024 Jul 09.
DOI: 10.1016/j.surg.2024.05.040
Abstrakt: Background: There is variation in the probability of nodal metastases from low-grade appendiceal adenocarcinomas, and the role of right colectomy is unclear. We aimed to define the prevalence and utility of lymphovascular invasion in predicting the risk of nodal metastases to help stratify patients who may benefit from right hemicolectomy.
Methods: Patients with nonmetastatic low-grade appendiceal adenocarcinomas were identified from the National Cancer Database (2010-2017). The primary outcome was probability of nodal metastases. Logistic regression was used to identify independent predictors of nodal metastases. A 4-tier risk model-the COH Composite Score-was calculated by assigning 1 point each for a high-risk feature (lymphovascular invasion, T3/T4 T stage, or nonmucinous histology). Survival analysis was performed using the Kaplan-Meier method. Multivariate Cox regression analysis was used to identify independent predictors of survival.
Results: A total of 1,303 patients with nonmetastatic low-grade appendiceal adenocarcinomas (64.2% mucinous) were identified. Of the 1,133 patients with known lymphovascular invasion status, 78 (6.9%) were lymphovascular invasion positive. In multivariate analysis, lymphovascular invasion was independently associated with nodal metastases (odds ratio, 8.68; P < .001). Overall accuracy of lymphovascular invasion in predicting nodal metastases was 86%. The COH Composite Score stratified patients in 4 categories with increasing risk of nodal metastases and incrementally worse survival. For patients with the COH Composite Score of 0 (12%), the nodal metastasis rate was 3.1%, and a right hemicolectomy in this group did not improve survival.
Conclusion: The presence of lymphovascular invasion is strongly predictive of nodal metastases. Lymphovascular invasion as part of the COH Composite Score may help guide the extent of surgery in low-grade appendiceal adenocarcinomas.
(Copyright © 2024 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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