Annals of Surgical Oncology, 2018, Vol.25(8), pp.2391-2399
To access, purchase, authenticate, or subscribe to the full-text of this article, please visit this link: http://dx.doi.org/10.1245/s10434-018-6560-0 Byline: Erica S. Tsang (1,2), Yarrow J. McConnell (3,4), David F. Schaeffer (5,6), Lawrence Lee (5,6), Yaling Yin (7), Siham Zerhouni (4), Kimberly Schaff (8), Caroline Speers (7), Hagen F. Kennecke (1,9) Abstract: Background Goblet cell carcinoids (GCCs) of the appendix are rare mucinous neoplasms, for which optimal therapy is poorly described. We examined prognostic clinical and treatment factors in a population-based cohort. Methods Patients diagnosed with GCC from 1984 to 2014 were identified from the British Columbia Cancer Agency and the Vancouver Lower Mainland Pathology Archive. Results Of 88 cases with confirmed appendiceal GCCs, clinical data were available in 86 cases (annual population incidence: 0.66/1,000,000). Median age was 54 years (range 25--91) and 42 patients (49%) were male. Metastasis at presentation was the strongest predictor of overall survival (OS), with median OS not reached for stage I--III patients, and measuring 16.2 months [95% confidence interval (CI) 9.1--29] for stage IV patients. In 67 stage I--III patients, 51 (76%) underwent completion hemicolectomy and 9 (17%) received adjuvant 5-fluorouracil-based chemotherapy. No appendicitis at initial presentation and Tang B histology were the only prognostic factors, with inferior 5-year recurrence-free survival (53 vs. 83% with appendicitis, p=0.02 45% Tang B vs. 89% Tang A, p〈0.01). Of 19 stage IV patients, 10 (62.5%) received 5-fluorouracil-based chemotherapy and 11 (61%) underwent multiorgan resection (MOR)[+ or -]hyperthermic intraperitoneal chemotherapy (HIPEC). Low mitotic rate and MOR[+ or -]HIPEC were associated with improved 2-year OS, but only MOR[+ or -]HIPEC remained significant on multivariate analysis (hazard ratio 5.4, 95% CI 1.4--20.9 p=0.015). Conclusions In this population-based cohort, we demonstrate excellent survival outcomes in stage I--III appendiceal GCCs and clinical appendicitis. Hemicolectomy remains the standard treatment. In metastatic disease, outcomes remain poor, although MOR[+ or -]HIPEC may improve survival. Author Affiliation: (1) 0000 0001 0702 3000, grid.248762.d, Division of Medical Oncology, British Columbia Cancer Agency, Vancouver, BC, Canada (2) 0000 0001 2288 9830, grid.17091.3e, Department of Medicine, University of British Columbia, Vancouver, BC, Canada (3) Puyallup General Surgery, Proliance Surgeons, Puyallup, WA, USA (4) 0000 0001 2288 9830, grid.17091.3e, Department of Surgery, University of British Columbia, Vancouver, BC, Canada (5) 0000 0001 2288 9830, grid.17091.3e, Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada (6) 0000 0001 0684 7796, grid.412541.7, Division of Anatomic Pathology, Vancouver General Hospital, Vancouver, BC, Canada (7) 0000 0001 0702 3000, grid.248762.d, Gastrointestinal Cancer Outcomes Unit, British Columbia Cancer Agency, Vancouver, BC, Canada (8) 0000 0001 0702 3000, grid.248762.d, Provincial Pharmacy, British Columbia Cancer Agency, Vancouver, BC, Canada (9) 0000 0001 2219 0587, grid.416879.5, Virginia Mason Cancer Institute, Virginia Mason Hospital and Seattle Medical Center, Seattle, WA, USA Article History: Registration Date: 06/06/2018 Received Date: 19/10/2017 Online Date: 18/06/2018 Article note: Electronic supplementary material The online version of this article (https://doi.org/10.1245/s10434-018-6560-0) contains supplementary material, which is available to authorized users.
Surgery – Analysis ; Command and Control Systems – Analysis ; Cancer Metastasis – Care and Treatment ; Cancer Metastasis – Analysis ; Appendicitis – Care and Treatment ; Appendicitis – Analysis ; Chemotherapy – Analysis ; Resveratrol – Analysis;
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