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Waheed MT, Malik I, Blakely AM, Zerhouni Y, Hanna M, Melstrom K, Lai LL, Kaiser AM, Thinzar L, Paz IB, Raoof M. Who should get a right colectomy in low-grade appendiceal adenocarcinomas? Association of lymphovascular invasion and nodal metastases. Surgery 2024; 176:560-568. [PMID: 38987096 DOI: 10.1016/j.surg.2024.05.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 05/21/2024] [Accepted: 05/24/2024] [Indexed: 07/12/2024]
Abstract
BACKGROUND There is variation in the probability of nodal metastases from low-grade appendiceal adenocarcinomas, and the role of right colectomy is unclear. We aimed to define the prevalence and utility of lymphovascular invasion in predicting the risk of nodal metastases to help stratify patients who may benefit from right hemicolectomy. METHODS Patients with nonmetastatic low-grade appendiceal adenocarcinomas were identified from the National Cancer Database (2010-2017). The primary outcome was probability of nodal metastases. Logistic regression was used to identify independent predictors of nodal metastases. A 4-tier risk model-the COH Composite Score-was calculated by assigning 1 point each for a high-risk feature (lymphovascular invasion, T3/T4 T stage, or nonmucinous histology). Survival analysis was performed using the Kaplan-Meier method. Multivariate Cox regression analysis was used to identify independent predictors of survival. RESULTS A total of 1,303 patients with nonmetastatic low-grade appendiceal adenocarcinomas (64.2% mucinous) were identified. Of the 1,133 patients with known lymphovascular invasion status, 78 (6.9%) were lymphovascular invasion positive. In multivariate analysis, lymphovascular invasion was independently associated with nodal metastases (odds ratio, 8.68; P < .001). Overall accuracy of lymphovascular invasion in predicting nodal metastases was 86%. The COH Composite Score stratified patients in 4 categories with increasing risk of nodal metastases and incrementally worse survival. For patients with the COH Composite Score of 0 (12%), the nodal metastasis rate was 3.1%, and a right hemicolectomy in this group did not improve survival. CONCLUSION The presence of lymphovascular invasion is strongly predictive of nodal metastases. Lymphovascular invasion as part of the COH Composite Score may help guide the extent of surgery in low-grade appendiceal adenocarcinomas.
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Affiliation(s)
- Muhammad Talha Waheed
- Department of Surgery, City of Hope National Medical Center, Duarte, CA. https://twitter.com/mtalhawaheed
| | - Ibrahim Malik
- Department of Surgery, City of Hope National Medical Center, Duarte, CA
| | - Andrew M Blakely
- Surgical Oncology Program, National Cancer Institute, National Institutes of Health, Bethesda, MD. https://twitter.com/AMBlakely
| | - Yasmine Zerhouni
- Department of Surgery, City of Hope National Medical Center, Duarte, CA
| | - Mark Hanna
- Department of Surgery, City of Hope National Medical Center, Duarte, CA. https://twitter.com/DrMarkhhanna
| | - Kurt Melstrom
- Department of Surgery, City of Hope National Medical Center, Duarte, CA. https://twitter.com/laleh_melstrom
| | - Lily L Lai
- Department of Surgery, City of Hope National Medical Center, Duarte, CA
| | - Andreas M Kaiser
- Department of Surgery, City of Hope National Medical Center, Duarte, CA. https://twitter.com/AndreasMKaiser
| | - Lwin Thinzar
- Department of Surgery, City of Hope National Medical Center, Duarte, CA. https://twitter.com/thinzarr
| | - Isaac B Paz
- Department of Surgery, City of Hope National Medical Center, Duarte, CA
| | - Mustafa Raoof
- Department of Surgery, City of Hope National Medical Center, Duarte, CA.
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2
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Rodriguez Franco S, Ghaffar SA, Jin Y, Weiss R, Hamermesh M, Khomiak A, Sugawara T, Franklin O, Leal AD, Lieu CH, Schulick RD, Del Chiaro M, Ahrendt S, McCarter MD, Gleisner AL. Pathological Features Associated with Lymph Node Disease in Patients with Appendiceal Neuroendocrine Tumors. Cancers (Basel) 2024; 16:2922. [PMID: 39199692 PMCID: PMC11352421 DOI: 10.3390/cancers16162922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2024] [Revised: 08/13/2024] [Accepted: 08/21/2024] [Indexed: 09/01/2024] Open
Abstract
This study aimed to evaluate the role of pathological features beyond tumor size in the risk of lymph node metastasis in appendiceal neuroendocrine tumors. Analyzing data from the national cancer database, we found that among 5353 cases, 18.8% had lymph node metastasis. Focusing on tumors smaller than 2 cm, a subject of considerable debate in treatment strategies, we identified lymphovascular invasion as one of the strongest predictors of lymph node disease. Interestingly, extension into the subserosa and beyond, a current factor in the staging system, was not a strong predictor. These findings suggest that careful interpretation of pathological features is needed when selecting therapeutic approaches using current staging systems.
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Affiliation(s)
- Salvador Rodriguez Franco
- Division of Surgical Oncology, Department of Surgery, University of Colorado, Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Sumaya Abdul Ghaffar
- Division of Surgical Oncology, Department of Surgery, University of Colorado, Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Ying Jin
- Department of Biostatistics and Informatics, University of Colorado, Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Reed Weiss
- Division of Surgical Oncology, Department of Surgery, University of Colorado, Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Mona Hamermesh
- Division of Surgical Oncology, Department of Surgery, University of Colorado, Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Andrii Khomiak
- Division of Surgical Oncology, Department of Surgery, University of Colorado, Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Toshitaka Sugawara
- Division of Surgical Oncology, Department of Surgery, University of Colorado, Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Oskar Franklin
- Division of Surgical Oncology, Department of Surgery, University of Colorado, Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Alexis D. Leal
- Division of Medical Oncology, School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, CO 80045, USA
- Cancer Center, University of Colorado, Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Christopher H. Lieu
- Division of Medical Oncology, School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, CO 80045, USA
- Cancer Center, University of Colorado, Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Richard D. Schulick
- Division of Surgical Oncology, Department of Surgery, University of Colorado, Anschutz Medical Campus, Aurora, CO 80045, USA
- Cancer Center, University of Colorado, Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Marco Del Chiaro
- Division of Surgical Oncology, Department of Surgery, University of Colorado, Anschutz Medical Campus, Aurora, CO 80045, USA
- Cancer Center, University of Colorado, Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Steven Ahrendt
- Division of Surgical Oncology, Department of Surgery, University of Colorado, Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Martin D. McCarter
- Division of Surgical Oncology, Department of Surgery, University of Colorado, Anschutz Medical Campus, Aurora, CO 80045, USA
- Cancer Center, University of Colorado, Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Ana L. Gleisner
- Division of Surgical Oncology, Department of Surgery, University of Colorado, Anschutz Medical Campus, Aurora, CO 80045, USA
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3
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Butz F, Dukaczewska A, Kunze CA, Krömer JM, Reinhard L, Jann H, Fehrenbach U, Müller-Debus CF, Skachko T, Pratschke J, Goretzki PE, Mogl MT, Dobrindt EM. Influence of Lymphatic, Microvascular and Perineural Invasion on Oncological Outcome in Patients with Neuroendocrine Tumors of the Small Intestine. Cancers (Basel) 2024; 16:305. [PMID: 38254794 PMCID: PMC10813650 DOI: 10.3390/cancers16020305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 01/03/2024] [Accepted: 01/09/2024] [Indexed: 01/24/2024] Open
Abstract
For the histopathological work-up of resected neuroendocrine tumors of the small intestine (siNET), the determination of lymphatic (LI), microvascular (VI) and perineural (PnI) invasion is recommended. Their association with poorer prognosis has already been demonstrated in many tumor entities. However, the influence of LI, VI and PnI in siNET has not been sufficiently described yet. A retrospective analysis of all patients treated for siNET at the ENETS Center of Excellence Charité-Universitätsmedizin Berlin, from 2010 to 2020 was performed (n = 510). Patients who did not undergo primary resection or had G3 tumors were excluded. In the entire cohort (n = 161), patients with LI, VI and PnI status had more distant metastases (48.0% vs. 71.4%, p = 0.005; 47.1% vs. 84.4%, p < 0.001; 34.2% vs. 84.7%, p < 0.001) and had lower rates of curative surgery (58.0% vs. 21.0%, p < 0.001; 48.3% vs. 16.7%, p < 0.001; 68.4% vs. 14.3%, p < 0.001). Progression-free survival was significantly reduced in patients with LI, VI or PnI compared to patients without. This was also demonstrated in patients who underwent curative surgery. Lymphatic, vascular and perineural invasion were associated with disease progression and recurrence in patients with siNET, and these should therefore be included in postoperative treatment considerations.
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Affiliation(s)
- Frederike Butz
- Department of Surgery, Campus Charité Mitte|Campus Virchow-Klinikum, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany
| | - Agata Dukaczewska
- Department of Surgery, Campus Charité Mitte|Campus Virchow-Klinikum, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany
| | - Catarina Alisa Kunze
- Department of Pathology, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany
| | - Janina Maren Krömer
- Department of Surgery, Campus Charité Mitte|Campus Virchow-Klinikum, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany
| | - Lisa Reinhard
- Department of Surgery, Campus Charité Mitte|Campus Virchow-Klinikum, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany
| | - Henning Jann
- Department of Hepatology and Gastroenterology, Campus Charité Mitte|Campus Virchow-Klinikum, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany
| | - Uli Fehrenbach
- Department of Radiology, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany
| | - Charlotte Friederieke Müller-Debus
- Department of Surgery, Campus Charité Mitte|Campus Virchow-Klinikum, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany
| | - Tatiana Skachko
- Department of Surgery, Campus Charité Mitte|Campus Virchow-Klinikum, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany
| | - Johann Pratschke
- Department of Surgery, Campus Charité Mitte|Campus Virchow-Klinikum, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany
| | - Peter E. Goretzki
- Department of Surgery, Campus Charité Mitte|Campus Virchow-Klinikum, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany
| | - Martina T. Mogl
- Department of Surgery, Campus Charité Mitte|Campus Virchow-Klinikum, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany
| | - Eva Maria Dobrindt
- Department of Surgery, Campus Charité Mitte|Campus Virchow-Klinikum, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany
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4
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Rich BS, Dicken BJ, Billmire DF, Weil BR, Ross J, Fallahazad N, Krailo M, Shaikh F, Frazier AL, Hazard FK, Nuño MM. Characterizing Lymphovascular Invasion in Pediatric and Adolescent Malignant Ovarian Nongerminomatous Germ Cell Tumors: A Report from the Children's Oncology Group. J Pediatr Surg 2023; 58:2399-2404. [PMID: 37699777 PMCID: PMC10872999 DOI: 10.1016/j.jpedsurg.2023.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 08/11/2023] [Accepted: 08/15/2023] [Indexed: 09/14/2023]
Abstract
BACKGROUND Lymphovascular invasion (LVI) has been identified as a poor prognostic factor for a variety of tumors; however, its significance in malignant ovarian germ cell tumors (MOGCT) in pediatric and adolescent patients is not well described. We aim to clarify the significance of LVI in the subset of patients with nongerminomatous MOGCT. METHODS Records of patients 0-20 years of age with MOGCT enrolled on Children's Oncology Group study AGCT0132 were reviewed. Patients with documented presence or absence of LVI in either institutional or central review pathology reports were included. RESULTS Of 130 patients with MOGCTs, 83 patients had of the presence or absence of LVI documented in their pathology report. 42/83 patients (50.6%) were found to have LVI present. The estimated odds of having LVI was higher in patients with stage II and III disease, 11 years and older and with the presence of choriocarcinoma. Event-free survival (EFS) and overall survival (OS) remained high in patients with LVI. Approximately 50% of patients with a documented LVI status in either institutional pathology report or central review were found to have LVI. CONCLUSIONS The presence of LVI was higher in tumors with adverse risk factors including higher stage and age greater than 11 years. While LVI was not associated with EFS or OS in the intermediate risk group, further work is necessary to determine the effect of LVI on long-term disease-free survival. We, therefore, recommend routinely incorporating LVI status into institutional pathology reports for pediatric and adolescent patients with MOGCT. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Barrie S Rich
- Division of Pediatric Surgery, Cohen Children's Medical Center, Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY, USA.
| | - Bryan J Dicken
- Division of Pediatric Surgery, University of Alberta, Edmonton Canada
| | - Deborah F Billmire
- Division of Pediatric Surgery, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Brent R Weil
- Division of Pediatric Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Jonathan Ross
- Department of Urology, Department of Pediatrics, Rush Medical College, Chicago, IL, USA
| | - Negar Fallahazad
- Children's Oncology Group, Public Health Institute, Monrovia, CA, USA
| | - Mark Krailo
- Children's Oncology Group, Public Health Institute, Monrovia, CA, USA; Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USA
| | - Furqan Shaikh
- Division of Haematology/Oncology, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - A Lindsay Frazier
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center Harvard Medical School, Boston, MA, USA
| | - Florette K Hazard
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
| | - Michelle M Nuño
- Children's Oncology Group, Public Health Institute, Monrovia, CA, USA; Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USA
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5
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Shibahara Y, Krzyzanowska M, Vajpeyi R. Appendiceal Well-Differentiated Neuroendocrine Tumors: A Single-Center Experience and New Insights into the Effective Use of Immunohistochemistry. Int J Surg Pathol 2022; 31:252-259. [PMID: 35491663 PMCID: PMC10101181 DOI: 10.1177/10668969221095172] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background. Appendiceal well-differentiated neuroendocrine tumor is the most common histological type of appendiceal tumor. The majority of tumors are found incidentally at the tip of the appendix, with few exceptions. Due to its primarily indolent nature, this entity presents unique pathological challenges, particularly in the appropriate use of immunohistochemistry which this study aims to clarify. Patients and methods. Patients diagnosed at University Health Network (Canada) between 2005–2019 were selected and reviewed. Results. We identified 70 patients and sex distribution was female 60%; median age 36.5 years. Among them, 63 patients underwent appendectomy, and seven had initial right hemicolectomy for non-appendix lesions. Mean tumor size was 5.0 mm. Tumor extent was submucosa (15%); muscularis propria (34%); subserosa or mesoappendix (42%); visceral peritoneum (8%). All were clinically non-functional and negative for nodal and distant metastasis. Ninety percent of tumors were WHO Grade 1; 10% were WHO Grade 2. Immunohistochemically, an average of six stains were performed per patient. Nearly all tumors were positive for chromogranin A, synaptophysin, CAM5.2, and CDX2. MIB-1 staining was < 3% in 58/63 tumors. Other immunohistochemical stainings performed were hormonal markers (serotonin, glucagon, pancreatic peptide, peptide YY). Subsequent right hemicolectomy was performed on five patients. All were followed up (median 4 years 8 months), and all were alive without recurrence except for one patient who died of another comorbidity. Conclusion. Tumors that are small, localized, and of low grade can be reasonably exempt from an extensive immunohistochemical panel in the absence of non-typical clinical and morphological features.
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Affiliation(s)
- Yukiko Shibahara
- Anatomical Pathology, Laboratory Medicine Program, University Health Network, Toronto, Canada
- Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada
- Department of Pathology, Kitasato University, Sagamihara, Japan
| | - Monika Krzyzanowska
- Cancer Quality Lab (CQuaL), Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
- Management and Evaluation, Institute of Health Policy, University of Toronto, Toronto, Canada
- Department of Medicine, University Health Network, Toronto, Canada
| | - Rajkumar Vajpeyi
- Anatomical Pathology, Laboratory Medicine Program, University Health Network, Toronto, Canada
- Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada
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6
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Cai Y, Liu Z, Jiang L, Ma D, Zhou Z, Ju H, Zhu Y. Patterns of Lymph Node Metastasis and Optimal Surgical Strategy in Small (≤20 mm) Gastroenteropancreatic Neuroendocrine Tumors. Front Endocrinol (Lausanne) 2022; 13:871830. [PMID: 35937823 PMCID: PMC9350735 DOI: 10.3389/fendo.2022.871830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 05/24/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Regional lymph node metastasis (LNM) is crucial for planning additional lymphadenectomy, and is directly correlated with poor prognosis in gastroenteropancreatic neuroendocrine tumors (GEP-NETs). However, the patterns of LNM for small (≤20 mm) GEP-NETs remain unclear. This population-based study aimed at evaluating LNM patterns and identifying optimal surgical strategies from the standpoint of lymph node dissemination. METHODS This retrospective cohort study retrieved data from the Surveillance, Epidemiology, and End Results (SEER) 18 registries database for 17,308 patients diagnosed as having localized well-differentiated GEP-NETs ≤ 20 mm between January 1, 2004, and December 31, 2017. The patterns of LNM were characterized in 6,622 patients who underwent extended resection for adequate lymph node harvest. RESULTS Of 6,622 patients with localized small GEP-NETs in the current study, 2,380 (36%) presented with LNM after regional lymphadenectomy. Nodal involvement was observed in approximately 7.4%, 49.1%, 13.6%, 53.7%, 13.8%, 7.8%, and 15.4% of gastric (g-), small intestinal (si-), appendiceal (a-), colonic (c-), rectal (r-), non-functional pancreatic (nfp-), and functional pancreatic (fp-) NETs ≤ 20 mm. Patients with younger age, larger tumor size, and muscularis invasion were more likely to present with LNM. Additional lymphadenectomy conferred a significant survival advantage in NETs (≤10 mm: HR, 0.47; 95% CI, 0.33-0.66; p < 0.001; 11-20 mm: HR, 0.54; 95% CI, 0.34-0.85; p = 0.008) and fp-NETs ≤ 20 mm (HR, 0.08; 95% CI, 0.02-0.36; p = 0.001), as well as g-NETs (HR, 0.39; 95% CI, 0.16-0.96; p = 0.041) and c-NETs of 11-20 mm (HR, 0.07; 95% CI, 0.01-0.48; p = 0.007). Survival benefits of additional lymphadenectomy were not found in a-NETs, r-NETs, and nfp-NETs with a small size. CONCLUSIONS Given the increased risk for nodal metastasis, primary tumor resection with regional lymphadenectomy is a potential optimal surgical strategy for si-NETs and fp-NETs ≤ 20 mm, as well as g-NETs and c-NETs of 11-20 mm. Local resection is an appropriate and reliable surgical approach for a-NETs, r-NETs, and nfp-NETs ≤ 20 mm.
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Affiliation(s)
| | | | | | | | | | - Haixing Ju
- *Correspondence: Yuping Zhu, ; Haixing Ju,
| | - Yuping Zhu
- *Correspondence: Yuping Zhu, ; Haixing Ju,
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7
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Nguyen AH, O'Leary MP, De Andrade JP, Ituarte PG, Warner SG, Melstrom LG, Kessler J, Fong Y, Li D, Singh G. Presentation and survival of gastro-entero-pancreatic neuroendocrine tumors in young adults versus older patients. Am J Surg 2021; 223:939-944. [PMID: 34474917 DOI: 10.1016/j.amjsurg.2021.08.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 08/02/2021] [Accepted: 08/16/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND A minority of patients with gastro-entero-pancreatic neuroendocrine tumors (GEP-NETs) is diagnosed at younger age. This population-based study explores the broad clinical and pathologic features of the youngest 5% of adult patients with GEP-NETs. METHODS A retrospective study of the National Cancer Database (NCDB) of patients with a primary GEP-NET was performed. Patients were stratified by age. Kaplan-Meier and multivariate Cox proportional hazards analyses were performed. RESULTS We identified 31,983 patients with a diagnosis of a GEP-NET and only 5% of patients were under the age of 35. Young patients were found to have greater proportions of localized, well differentiated disease. On multivariate analysis, young age, well differentiated histology, early stage, and surgical intervention were associated with lower risk of mortality. CONCLUSIONS Young patients with GEP-NETs tend to have earlier stage of presentation and well differentiated tumors, which may be most amenable to surgical intervention.
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Affiliation(s)
- Andrew H Nguyen
- Department of Surgery, City of Hope National Medical Center, 1500 East Duarte Road, Duarte, CA, 91010, USA
| | - Michael P O'Leary
- Department of Surgery, City of Hope National Medical Center, 1500 East Duarte Road, Duarte, CA, 91010, USA
| | - James P De Andrade
- Department of Surgery, University of Iowa Health Care, 200 Hawkins Drive, Iowa City, IA, USA
| | - Philip G Ituarte
- Department of Surgery, City of Hope National Medical Center, 1500 East Duarte Road, Duarte, CA, 91010, USA
| | - Susanne G Warner
- Department of Surgery, City of Hope National Medical Center, 1500 East Duarte Road, Duarte, CA, 91010, USA
| | - Laleh G Melstrom
- Department of Surgery, City of Hope National Medical Center, 1500 East Duarte Road, Duarte, CA, 91010, USA
| | - Jonathan Kessler
- Department of Radiology, City of Hope National Medical Center, 1500 East Duarte Road, Duarte, CA, 91010, USA
| | - Yuman Fong
- Department of Surgery, City of Hope National Medical Center, 1500 East Duarte Road, Duarte, CA, 91010, USA
| | - Daneng Li
- Department of Medical Oncology, City of Hope National Medical Center, 1500 East Duarte Road, Duarte, CA, 91010, USA
| | - Gagandeep Singh
- Department of Surgery, City of Hope National Medical Center, 1500 East Duarte Road, Duarte, CA, 91010, USA.
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8
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Alexandraki KI, Kaltsas G, Grozinsky-Glasberg S, Oleinikov K, Kos-Kudła B, Kogut A, Srirajaskanthan R, Pizanias M, Poulia KA, Ferreira C, Weickert MO, Daskalakis K. The effect of prophylactic surgery in survival and HRQoL in appendiceal NEN. Endocrine 2020; 70:178-186. [PMID: 32524502 PMCID: PMC7524808 DOI: 10.1007/s12020-020-02356-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 05/15/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND/AIMS Long-term outcomes are understudied in patients with well-differentiated appendiceal neuroendocrine neoplasms (WD-ANENs). We aimed to evaluate the validity of currently applied criteria for completion prophylactic right hemicolectomy (pRHC) and determine its association with patient outcomes, including health-related quality of life (HRQoL). METHODS Eligible patients from five European referral centers were divided between those who underwent appendectomy alone and those who underwent completion pRHC. HRQoL EORTC-QLC-C30 questionnaires and cross-sectional imaging data were prospectively collected. Age- and sex-matched healthy controls were recruited for HRQoL analysis' validation. RESULTS We included 166 patients (119 women [71.2%]: mean age at baseline: 31 ± 16 years). Mean follow-up was 50.9 ± 54 months. Most patients (152 [92%]) had tumors ≤20 mm in size. Fifty-eight patients (34.9%) underwent pRHC that in final analysis was regarded as an overtreatment in 38/58 (65.5%). In multivariable analysis, tumor size >20 mm was the only independent predictor for lymph node (LN) involvement (p = 0.002). No mortality was reported, whereas 2-, 5- and 10-year recurrence-free survival in patients subjected to postoperative cross-sectional imaging (n = 136) was 98.5%, 97.8%, and 97.8%, respectively. Global HRQoL was not significantly impaired in patients with WD-ANEN compared with age- and sex-matched healthy individuals (median scores 0.83[0.08-1] vs 0.83[0.4-1], respectively; p = 0.929). Among patients with WD-ANEN impaired social functioning (p = 0.016), diarrhea (p = 0.003) and financial difficulties (0.024) were more frequently reported in the pRHC group. CONCLUSIONS WD-ANEN is a low-malignant neoplasm with unconfirmed associated mortality, low recurrence rate, and overall preserved HRQoL. pRHC comes at a price of excessive surgery, functional HRQoL issues, and diarrhea. The value per se of a prophylactic surgical approach to patients with WD-ANENs <20 mm is challenged.
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Affiliation(s)
- Krystallenia I Alexandraki
- Endocrine Oncology Unit, 1st Department of Propaupedic Internal Medicine, Laiko Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Gregory Kaltsas
- Endocrine Oncology Unit, 1st Department of Propaupedic Internal Medicine, Laiko Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Simona Grozinsky-Glasberg
- Neuroendocrine Tumour Unit, ENETS CoE, Endocrinology and Metabolism Department, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Kira Oleinikov
- Neuroendocrine Tumour Unit, ENETS CoE, Endocrinology and Metabolism Department, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Beata Kos-Kudła
- Department of Endocrinology and Neuroendocrine Neoplasms, Department of Endocrinology and Pathophysiology, Medical University of Silesia, Katowice, Poland
| | - Angelika Kogut
- Department of Endocrinology and Neuroendocrine Neoplasms, Department of Endocrinology and Pathophysiology, Medical University of Silesia, Katowice, Poland
| | - Rajaventhan Srirajaskanthan
- ENETS Centre of Excellence, Neuroendocrine Tumour Unit, King's College Hospital, London, SE5 9RS, UK
- Department of Gastroenterology, King's College Hospital, London, SE5 9RS, UK
| | - Michail Pizanias
- Department of Liver Transplantation, Hepatobiliary Pancreatic Surgery, King's Healthcare Partners, King's College Hospital, NHS FT, Institute of Liver Studies, Denmark Hill, London, UK
| | | | - Clara Ferreira
- Department of Nuclear Medicine, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Martin O Weickert
- The ARDEN NET Centre, European Neuroendocrine Tumour Society (ENETS) Centre of Excellence (CoE), University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
- Clinical Sciences Research Laboratories, Warwick Medical School, University of Warwick, University Hospital, Coventry, UK
- Centre of Applied Biological & Exercise Sciences, Faculty of Health & Life Sciences, Coventry University, Coventry, UK
| | - Kosmas Daskalakis
- Endocrine Oncology Unit, 1st Department of Propaupedic Internal Medicine, Laiko Hospital, National and Kapodistrian University of Athens, Athens, Greece.
- Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
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9
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Dominguez DA, Aversa JG, Hagerty BL, Diggs LP, Raoof M, Davis JL, Hernandez JM, Blakely AM. Prognostic impact of lymphovascular invasion in pT1-T3 gallbladder adenocarcinoma. J Surg Oncol 2020; 122:1401-1408. [PMID: 32783204 DOI: 10.1002/jso.26160] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 07/30/2020] [Indexed: 01/06/2023]
Abstract
BACKGROUND Most gallbladder cancers are diagnosed after cholecystectomy for presumed benign disease, and nodal staging to inform subsequent treatment is therefore often lacking. We evaluated the association of lymphovascular invasion (LVI) with regional lymph node involvement in gallbladder adenocarcinoma and its impact on survival. METHODS The National Cancer Database was queried to identify patients with resected gallbladder adenocarcinoma and with available staging and LVI status. Patients with pT4 and M1 disease were excluded. Univariable and multivariable regression identified factors associated with positive lymph nodes. Cox proportional hazards model was used to evaluate overall survival (OS). RESULTS Of 1649 patients with available LVI status, 1142 (69.7%) had at least one positive lymph node and 765 (46.4%) had LVI. On multivariable regression, presence of LVI was the strongest predictor of positive lymph nodes (odds ratio, 3.69; P < .001). The positive predictive value of LVI for positive lymph nodes in pT2 and pT3 tumors was 80.1% and 90.5%, respectively. LVI was independently associated with decreased OS (hazard ratio, 1.21; P = .001), as were node-positive disease and increasing T stage. CONCLUSION In patients with gallbladder adenocarcinoma, LVI is independently associated with regional lymph node metastases and abbreviated OS. LVI status may help risk-stratify patients following initial cholecystectomy and inform subsequent treatment.
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Affiliation(s)
- Dana A Dominguez
- Surgical Oncology Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland.,Department of General Surgery, UCSF East Bay, Oakland, California
| | - John G Aversa
- Surgical Oncology Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Brendan L Hagerty
- Surgical Oncology Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Laurence P Diggs
- Surgical Oncology Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Mustafa Raoof
- Department of Surgery, City of Hope National Medical Center, Duarte, California
| | - Jeremy L Davis
- Surgical Oncology Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Jonathan M Hernandez
- Surgical Oncology Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Andrew M Blakely
- Surgical Oncology Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
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