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J Gastrointest Surg. 2019 Aug 19. doi: 10.1007/s11605-019-04336-4. [Epub ahead of print]

Should We Be Doing Cytoreductive Surgery with HIPEC for Signet Ring Cell Appendiceal Adenocarcinoma? A Study from the US HIPEC Collaborative.

Author information

1
Division of Surgical Oncology, Department of Surgery, University of Cincinnati College of Medicine, 231 Albert Sabin Way ML-0558, Cincinnati, OH, 45267-0558, USA.
2
Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
3
Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
4
Department of Gastrointestinal Oncology, Moffitt Cancer Center, Department of Oncologic Sciences, Morsani College of Medicine, Tampa, FL, USA.
5
Division of Surgical Oncology, Department of Surgery, University of California, San Diego, CA, USA.
6
Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA.
7
Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA.
8
Division of Hepatobiliary and Pancreas Surgery, Mayo Clinic, Rochester, MN, USA.
9
Division of Surgical Oncology, Department of Surgery, University of Massachusetts Medical School, Worcester, MA, USA.
10
Division of Surgical Oncology, Department of Surgery, University of Wisconsin, Madison, WI, USA.
11
Division of Surgical Oncology, Department of Surgery, City of Hope National Medical Center, Duarte, CA, USA.
12
Department of Surgery, Johns Hopkins University, Baltimore, MD, USA.
13
Division of Surgical Oncology, Department of Surgery, University of Cincinnati College of Medicine, 231 Albert Sabin Way ML-0558, Cincinnati, OH, 45267-0558, USA. patel5se@ucmail.uc.edu.

Abstract

BACKGROUND:

Appendiceal adenocarcinoma with signet ring cells (SCA) is associated with worse overall survival (OS), and it is unclear whether cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) should be pursued in this patient population. We assessed the prognostic implications of signet ring cells in patients with appendiceal adenocarcinoma and peritoneal carcinomatosis undergoing CRS-HIPEC.

METHODS:

The US HIPEC Collaborative, a 12-center, multi-institutional database of patients undergoing CRS-HIPEC, was reviewed for patients with SCA. Univariate and multivariate analyses were performed.

RESULTS:

Of 514 patients undergoing CRS-HIPEC for appendiceal adenocarcinoma, 125 (24%) had SCA. The SCA and non-SCA groups had similar baseline characteristics. SCA had worse OS compared with non-SCA (32.0 vs 91.4 months, p < 0.001). In univariate analysis for only SCA cases, there was worse OS in patients with poorly differentiated tumors, positive lymph nodes, LVI, PCI > 20, or incomplete cytoreduction (CC-2/3). However, multivariate analysis showed only positive lymph nodes (HR 1.14 [95% CI 1.00-1.31], p = 0.04), poor differentiation (5.60 [1.29-24.39], p = 0.02), and incomplete cytoreduction (4.90 [1.11-12.70], p = 0.03) were independently associated with decreased OS for SCA.

CONCLUSION:

While signet cells are a negative prognostic feature, they should not be a contraindication to CRS-HIPEC in patients with well-moderately differentiated tumors with negative lymph nodes, where complete cytoreduction can be achieved.

KEYWORDS:

Appendiceal adenocarcinoma; Cytoreductive surgery; Hyperthermic intraperitoneal chemotherapy; Signet ring cells

PMID:
31428960
DOI:
10.1007/s11605-019-04336-4

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