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Eur J Surg Oncol. 2019 Oct 15. pii: S0748-7983(19)30898-4. doi: 10.1016/j.ejso.2019.10.018. [Epub ahead of print]

The prognostic relevance of histologic subtype in appendiceal adenocarcinoma.

Author information

1
Department of Medical Oncology, Catharina Hospital, Eindhoven, the Netherlands; Department of Research, Netherlands Comprehensive Cancer Organisation, Eindhoven, the Netherlands. Electronic address: laura.legue@catharinaziekenhuis.nl.
2
Department of Research, Netherlands Comprehensive Cancer Organisation, Eindhoven, the Netherlands.
3
Department of Medical Oncology, Catharina Hospital, Eindhoven, the Netherlands.
4
Department of Research, Netherlands Comprehensive Cancer Organisation, Eindhoven, the Netherlands; Department of Surgical Oncology, Catharina Hospital, Eindhoven, the Netherlands; GROW, School for Oncology and Developmental Biology, Maastricht University, Maastricht, the Netherlands.
5
Department of Research, Netherlands Comprehensive Cancer Organisation, Eindhoven, the Netherlands; Department of Public Health, Erasmus MC University Medical Centre, Rotterdam, the Netherlands.
6
Department of Pathology, Laboratory for Pathology and Medical Microbiology (PAMM), Eindhoven, the Netherlands.

Abstract

BACKGROUND:

The aim of this population-based study was to determine the prognostic value of the histologic subtypes mucinous (MAC), non-mucinous (AC) and signet ring cell (SRCC) adenocarcinoma among patients with appendiceal cancer.

METHODS AND MATERIALS:

Data from the Netherlands Cancer Registry (NCR) of patients with primary appendiceal adenocarcinomas with MAC, AC and SRCC histologic subtype, diagnosed between 2001 and 2015 were used (n = 675). To categorize patients according to the recent histopathological classification, the NCR was linked with the Dutch Pathology Registry (PALGA). Log-rank tests and Kaplan-Meier analyses were performed to estimate overall survival (OS), and the cox proportional hazards model was run to identify prognostic factors.

RESULTS:

AC was the most frequently encountered histologic subtype (50.9%), followed by MAC (35.8%) and SRCC (13.3%). In locoregional disease, histologic subtype was not a prognostic factor for OS with 5-year survival rates for patients with AC, MAC and SRCC of 60.0%, 60.5% and 69.6% respectively (p = 0.68). Metastatic disease was more common in SRCC (53.8%) than in MAC (38.8%) and AC (23.4%) (p < 0.0001). Median OS for patients with metastatic disease was 12.6, 27.7 and 18.2 months in AC, MAC and SRCC respectively (p < 0.005). MAC was associated with higher survival compared to AC (HR 0.48, 95%CI 0.34-0.69). In subanalyses, MAC was only a positive prognostic factor compared to AC in patients with peritoneal metastases (HR 0.42, 95%CI 0.28-0.62).

CONCLUSION:

Histologic subtype had no prognostic relevance in locoregional or systemic metastatic disease in appendiceal adenocarcinoma. In peritoneal metastases, mucinous histologic subtype was a favorable prognostic factor, compared to non-mucinous and signet ring cell subtype.

KEYWORDS:

Appendiceal adenocarcinoma; Histology; Mucinous; Prognosis; Signet ring cell

PMID:
31668980
DOI:
10.1016/j.ejso.2019.10.018

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