Faculty Collaboration Database

Do Lymph Node Metastases Matter in Appendiceal Cancer with Peritoneal Carcinomatosis? A US HIPEC Collaborative Study. J Gastrointest Surg 2022 Dec;26(12):2569-2578

Date

10/19/2022

Pubmed ID

36258061

DOI

10.1007/s11605-022-05489-5

Scopus ID

2-s2.0-85140101531 (requires institutional sign-in at Scopus site)   2 Citations

Abstract

BACKGROUND: Whether formal regional lymph node (LN) evaluation is necessary for patients with appendiceal adenocarcinoma (AA) who have peritoneal metastases is unclear. The aim of this study was to evaluate the prognostic value of LN metastases on survival in patients treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC).

METHODS: A retrospective analysis of the US HIPEC collaborative, a multi-institutional consortium comprising 12 high-volume centers, was performed to identify patients with AA who underwent CRS-HIPEC with adequate LN sampling (≥ 12 LNs).

RESULTS: Two hundred-fifty patients with AA who underwent CRS-HIPEC were included. Outcomes were compared between LN - and LN + disease. Baseline patient characteristics between groups were similar, with most patients undergoing complete cytoreduction (0/1: 86.0% vs. 76.8%, p = 0.08), respectively. More adverse tumor factors were found in patients with LN + disease, including poor differentiation, signet ring cells, and lymphovascular invasion. Multivariate analysis of overall survival (OS) found LN + disease was independently associated with worse OS (HR: 2.82 95%CI: 1.25-6.34, p = 0.01), even after correction for receipt of systemic therapy. On Kaplan-Meier analysis, median OS was lower in patients with LN + disease (25.9 months vs. 91.4 months, p < 0.01). LN + disease remained associated with poor OS following propensity score matching (HR: 4.98 95%CI: 1.72-14.40, p < 0.01) and in patients with PCI ≥ 20 (HR: 3.68 95%CI: 1.54-8.80, p < 0.01).

CONCLUSIONS: In this large multi-institutional study of patients with AA undergoing CRS-HIPEC, LN status remained associated with worse OS even in the setting of advanced peritoneal carcinomatosis. Formal LN evaluation should be performed for most patients with AA undergoing CRS-HIPEC.

Author List

Turner KM, Morris MC, Delman AM, Hanseman D, Johnston FM, Greer J, Walle KV, Abbott DE, Raoof M, Grotz TE, Fournier K, Dineen S, Veerapong J, Maduekwe U, Kothari A, Staley CA, Maithel SK, Lambert LA, Kim AC, Cloyd JM, Wilson GC, Sussman JJ, Ahmad SA, Patel SH

Authors

Anai N. Kothari MD Assistant Professor in the Surgery department at Medical College of Wisconsin
Ugwuji N. Maduekwe MD Associate Dean, Associate Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adenocarcinoma
Adenocarcinoma, Mucinous
Antineoplastic Combined Chemotherapy Protocols
Appendiceal Neoplasms
Chemotherapy, Cancer, Regional Perfusion
Combined Modality Therapy
Cytoreduction Surgical Procedures
Follow-Up Studies
Humans
Hyperthermia, Induced
Lymphatic Metastasis
Percutaneous Coronary Intervention
Peritoneal Neoplasms
Prognosis
Retrospective Studies
Survival Rate