Search

Right hemicolectomy is recommended for appendiceal adenocarcinoma but may not be needed for early stage disease.This study aimed to determine whether appendectomy offers adequate oncologic outcomes for T1 appendiceal adenocarcinoma from a national cohort of patients.Patients with T1 appendiceal adenocarcinoma (mucinous and nonmucinous histology) treated with either a right hemicolectomy or appendectomy between 2004 and 2016 were retrieved. Multivariate Cox regression analysis was used to identify predictors of overall survival.The study was conducted using a national cancer database.A total of 320 patients (median age, 62 y; 47% women) were identified: 69 (22%) underwent an appendectomy and 251 (78%) underwent a right hemicolectomy.Overall survival was measured.Nonmucinous adenocarcinoma was identified in 194 (61%), whereas 126 (39%) had mucinous adenocarcinoma. Of the overall cohort, 43% had well-differentiated histology, 39% had moderately differentiated disease, and 4% had poorly differentiated tumors. The rate of lymph node metastasis was lower in well-differentiated tumors (3%) compared with moderately (10%) or poorly differentiated tumors (25%). On univariate survival analysis, right hemicolectomy was associated with improved 1-, 3-, and 5-year overall survival in patients with moderately/poorly differentiated disease ( p0.001) but not for well-differentiated disease ( p = 1.000). After adjustment, right hemicolectomy was associated with overall survival improvement for moderately/poorly differentiated T1 adenocarcinoma (HR = 0.26 [95% CI, 0.08-0.82]; p = 0.02) but not for well-differentiated disease.This study was limited by its retrospective nature.The current analysis from the National Cancer Database demonstrates that appendectomy is associated with equivalent survival to right hemicolectomy for well-differentiated T1 adenocarcinoma, whereas for moderately and poorly differentiated disease, right hemicolectomy is oncologically superior to appendectomy. See Video Abstract at http://links.lww.com/DCR/B689 .ANTECEDENTES:La hemicolectomía derecha se recomienda para el adenocarcinoma apendicular, pero puede no ser necesaria para la enfermedad en estadio temprano.OBJETIVO:Este estudio tuvo como objetivo determinar si la apendicectomía ofrece resultados oncológicos adecuados para el adenocarcinoma apendicular T1 de una cohorte nacional de pacientes.DISEÑO:Se recuperaron pacientes con adenocarcinoma apendicular T1 (histología mucinoso y no mucinoso) tratados con hemicolectomía derecha o apendicectomía entre 2004-2016. Se utilizó un análisis de regresión de Cox multivariante para identificar los predictores de la supervivencia global.ENTORNO CLÍNICO:Base de datos nacional sobre cáncer.PACIENTES:Se identificaron un total de 320 pacientes (mediana de edad 62 años, 47% mujeres): 69 (22%) se sometieron a una apendicectomía y 251 (78%) se sometieron a una hemicolectomía derecha.PRINCIPAL MEDIDA DE RESULTADO:Sobrevida global.RESULTADOS:Se identificó adenocarcinoma no mucinoso en 194 (61%) mientras que 126 (39%) tenían adenocarcinoma mucinoso. De la cohorte general, el 43% tenía una histología bien diferenciada, el 39% tenía una enfermedad moderadamente diferenciada y el 4% tenía tumores poco diferenciados. La tasa de metástasis en los ganglios linfáticos fue menor en los tumores bien diferenciados (3%) en comparación con los tumores moderadamente (10%) o pobremente diferenciados (25%). En el análisis de sobrevida univariante, la hemicolectomía derecha se asoció con una mejor sobrevida general a 1, 3, y 5 años en pacientes con enfermedad moderada / pobremente diferenciada ( p0,001) pero no para la enfermedad bien diferenciada ( p = 1,000). Después del ajuste, la hemicolectomía derecha se asoció con una mejora de la sobrevida general para el adenocarcinoma T1 moderadamente / poco diferenciado (HR = 0,26, IC del 95%: 0,08-0,82, p = 0,02) pero no para la enfermedad bien diferenciada.LIMITACIONES:Este estudio estuvo limitado por su naturaleza retrospectiva.CONCLUSIONES:El análisis actual de la base de datos nacional de cáncer demuestra que la apendicectomía se asocia con una sobrevida similar a la hemicolectomía derecha para el adenocarcinoma T1 bien diferenciado, mientras que para la enfermedad moderada y pobremente diferenciada, la hemicolectomía derecha es oncológicamente superior a la apendicectomía. Consulte Video Resumen en http://links.lww.com/DCR/B689 . (Traducción-Dr. Yazmin Berrones-Medina ).

PURPOSE/OBJECTIVE(S) Loss of the tumor suppressor gene SMAD4 is a critical genetic alteration in pancreatic carcinoma (PC). We hypothesized that SMAD4 status in PC is associated with outcomes in patients who received neoadjuvant (NARx) or adjuvant (ARx) radiotherapy. MATERIALS/METHODS PC patients who underwent surgical resection at two high-volume centers following NARx-or those treated with ARx-between 2008-2019 were identified. SMAD4 status was determined based on immunohistochemical staining and classified as preserved (SMAD4+) or lost (SMAD4-). Kaplan-Meier survival estimates and multivariate analysis were used to analyze correlations between SMAD4 status, radiation therapy, and clinical outcome measures. RESULTS A total of 290 patients (mean age at diagnosis 66 years, 51% female) were identified; 131 (45%) were SMAD4+ and 159 (55%) SMAD4-. Resectable disease was diagnosed in 95 (33%) and borderline-resectable disease in 166 (57%); 29 patients (10%) had locally-advanced disease. NARx was administered in 147 (51%) in combination with chemotherapy while 143 (49%) received ARx; 26 (18%) of which received ARx solely. NARx in SMAD4- PC was associated with a significantly increased incidence of near-complete/complete histopathologic response and reduced incidence of none/poor response compared to SMAD4- PC not treated with NARx (12% vs 2% and 44% vs 19% respectively, P = 0.001). On adjusted analysis, NARx was a significant predictor of histopathologic response in SMAD4- patients (HR: 3.5, 95% CI 1.6-7.6, P < 0.001) while no association was seen for SMAD4+ PC. Neither radiation therapy receipt nor SMAD4 status were associated with overall survival (OS). Yet, SMAD4- PC had a worsened disease-free survival (DFS) compared to SMAD4+ PC (19 vs 16 months, P = 0.03). This difference persisted even among patients who had received NARx (21 vs 16 months, P = 0.04) and those with histopathologic treatment response (24 vs 16 months, P = 0.031). No difference in DFS between SMAD4- and SMAD4+ PC was identified in the ARx group. Lastly, NARx, significantly improved local-recurrence free survival in SMAD4+ PC but not in SMAD4- PC (33 vs 21 months, P = 0.047). CONCLUSION `Outcomes following surgical resection for PC remain primarily driven by SMAD4 status irrespective of radiation therapy timing (NARx vs ARx). However, this analysis suggests that SMAD4 status may help identify a subset of patients who are most likely to benefit from NARx.