Abstract：
OBJECTIVE: The purpose of this study was to explore the appropriate surgical procedure and clinical decision for appendiceal adenocarcinoma.
METHODS: A total of 1,984 appendiceal adenocarcinoma patients from 2004 to 2015 were retrospectively identified from the Surveillance, Epidemiology, and End Results (SEER) database. All patients were divided into three groups based on the extent of surgical resection: appendectomy (N = 335), partial colectomy (N = 390) and right hemicolectomy (N = 1,259). The clinicopathological features and survival outcomes of three groups were compared, and independent prognostic factors were assessed.
RESULTS: The 5-year OS rates of patients who underwent appendectomy, partial colectomy and right hemicolectomy were 58.3%, 65.5% and 69.1%, respectively (right hemicolectomy vs appendectomy, P < 0.001; right hemicolectomy vs partial colectomy, P = 0.285; partial colectomy vs appendectomy, P = 0.045). The 5-year CSS rates of patients who underwent appendectomy, partial colectomy and right hemicolectomy were 73.2%, 77.0% and 78.7%, respectively (right hemicolectomy vs appendectomy, P = 0.046; right hemicolectomy vs partial colectomy, P = 0.545; partial colectomy vs appendectomy, P = 0.246). The subgroup analysis based on the pathological TNM stage indicated that there was no survival difference amongst three surgical procedures for stage I patients (5-year CSS rate: 90.8%, 93.9% and 98.1%, respectively). The prognosis of patients who underwent an appendectomy was poorer than that of those who underwent partial colectomy (5-year OS rate: 53.5% vs 67.1%, P = 0.005; 5-year CSS rate: 65.2% vs 78.7%, P = 0.003) or right hemicolectomy (5-year OS rate: 74.2% vs 53.23%, P < 0.001; 5-year CSS rate: 65.2% vs 82.5%, P < 0.001) for stage II disease. Right hemicolectomy did not show a survival advantage over partial colectomy for stage II (5-year CSS, P = 0.255) and stage III (5-year CSS, P = 0.846) appendiceal adenocarcinoma.
CONCLUSIONS: Right hemicolectomy may not always be necessary for appendiceal adenocarcinoma patients. An appendectomy could be sufficient for therapeutic effect of stage I patients, but limited for stage II patients. Right hemicolectomy was not superior to partial colectomy for advanced stage patients, suggesting omission of standard hemicolectomy might be feasible. However, adequate lymphadenectomy should be strongly recommended.
METHODS: A total of 1,984 appendiceal adenocarcinoma patients from 2004 to 2015 were retrospectively identified from the Surveillance, Epidemiology, and End Results (SEER) database. All patients were divided into three groups based on the extent of surgical resection: appendectomy (N = 335), partial colectomy (N = 390) and right hemicolectomy (N = 1,259). The clinicopathological features and survival outcomes of three groups were compared, and independent prognostic factors were assessed.
RESULTS: The 5-year OS rates of patients who underwent appendectomy, partial colectomy and right hemicolectomy were 58.3%, 65.5% and 69.1%, respectively (right hemicolectomy vs appendectomy, P < 0.001; right hemicolectomy vs partial colectomy, P = 0.285; partial colectomy vs appendectomy, P = 0.045). The 5-year CSS rates of patients who underwent appendectomy, partial colectomy and right hemicolectomy were 73.2%, 77.0% and 78.7%, respectively (right hemicolectomy vs appendectomy, P = 0.046; right hemicolectomy vs partial colectomy, P = 0.545; partial colectomy vs appendectomy, P = 0.246). The subgroup analysis based on the pathological TNM stage indicated that there was no survival difference amongst three surgical procedures for stage I patients (5-year CSS rate: 90.8%, 93.9% and 98.1%, respectively). The prognosis of patients who underwent an appendectomy was poorer than that of those who underwent partial colectomy (5-year OS rate: 53.5% vs 67.1%, P = 0.005; 5-year CSS rate: 65.2% vs 78.7%, P = 0.003) or right hemicolectomy (5-year OS rate: 74.2% vs 53.23%, P < 0.001; 5-year CSS rate: 65.2% vs 82.5%, P < 0.001) for stage II disease. Right hemicolectomy did not show a survival advantage over partial colectomy for stage II (5-year CSS, P = 0.255) and stage III (5-year CSS, P = 0.846) appendiceal adenocarcinoma.
CONCLUSIONS: Right hemicolectomy may not always be necessary for appendiceal adenocarcinoma patients. An appendectomy could be sufficient for therapeutic effect of stage I patients, but limited for stage II patients. Right hemicolectomy was not superior to partial colectomy for advanced stage patients, suggesting omission of standard hemicolectomy might be feasible. However, adequate lymphadenectomy should be strongly recommended.
摘要：
目的：本研究的目的是探讨阑尾腺癌的适当手术方式和临床决策。
方法：对2004年至2015年的1,984例阑尾腺癌患者进行回顾性分析，流行病学,和结束结果(SEER)数据库。根据手术切除程度将所有患者分为三组：阑尾切除术（N=335），部分结肠切除术（N=390）和右半结肠切除术（N=1,259）。比较3组患者的临床病理特征和生存结局,并评估独立的预后因素。
结果：阑尾切除术患者的5年OS率，部分结肠切除术和右半结肠切除术占58.3%，65.5%和69.1%，(分别为右半结肠切除术与阑尾切除术，P<0.001；右半结肠切除术与部分结肠切除术，P=0.285；部分结肠切除术与阑尾切除术，P=0.045)。接受阑尾切除术的患者的5年CSS率，部分结肠切除术和右半结肠切除术占73.2%，77.0%和78.7%，(分别为右半结肠切除术与阑尾切除术，P=0.046；右半结肠切除术与部分结肠切除术，P=0.545；部分结肠切除术与阑尾切除术，P=0.246）。基于病理TNM分期的亚组分析表明，I期患者的三种外科手术之间没有生存差异（5年CSS率：90.8％，93.9%和98.1%，分别)。接受阑尾切除术的患者的预后比接受部分结肠切除术的患者差（5年OS率：53.5％vs67.1％，P=0.005；5年CSS率：65.2%对78.7%，P=0.003）或右半结肠切除术（5年OS率：74.2％vs53.23％，P<0.001；5年CSS率：65.2%vs82.5%，对于II期疾病，P<0.001）。对于II期，右半结肠切除术未显示出部分结肠切除术的生存优势（5年CSS，P=0.255)和第三阶段(5年CSS，P=0.846)阑尾腺癌。
结论：阑尾腺癌患者并不总是需要右半结肠切除术。阑尾切除术可能足以达到I期患者的治疗效果，但仅限于II期患者。对于晚期患者，右半结肠切除术并不优于部分结肠切除术，提示省略标准半结肠切除术可能是可行的。然而,应强烈建议进行充分的淋巴结清扫术.
方法：对2004年至2015年的1,984例阑尾腺癌患者进行回顾性分析，流行病学,和结束结果(SEER)数据库。根据手术切除程度将所有患者分为三组：阑尾切除术（N=335），部分结肠切除术（N=390）和右半结肠切除术（N=1,259）。比较3组患者的临床病理特征和生存结局,并评估独立的预后因素。
结果：阑尾切除术患者的5年OS率，部分结肠切除术和右半结肠切除术占58.3%，65.5%和69.1%，(分别为右半结肠切除术与阑尾切除术，P<0.001；右半结肠切除术与部分结肠切除术，P=0.285；部分结肠切除术与阑尾切除术，P=0.045)。接受阑尾切除术的患者的5年CSS率，部分结肠切除术和右半结肠切除术占73.2%，77.0%和78.7%，(分别为右半结肠切除术与阑尾切除术，P=0.046；右半结肠切除术与部分结肠切除术，P=0.545；部分结肠切除术与阑尾切除术，P=0.246）。基于病理TNM分期的亚组分析表明，I期患者的三种外科手术之间没有生存差异（5年CSS率：90.8％，93.9%和98.1%，分别)。接受阑尾切除术的患者的预后比接受部分结肠切除术的患者差（5年OS率：53.5％vs67.1％，P=0.005；5年CSS率：65.2%对78.7%，P=0.003）或右半结肠切除术（5年OS率：74.2％vs53.23％，P<0.001；5年CSS率：65.2%vs82.5%，对于II期疾病，P<0.001）。对于II期，右半结肠切除术未显示出部分结肠切除术的生存优势（5年CSS，P=0.255)和第三阶段(5年CSS，P=0.846)阑尾腺癌。
结论：阑尾腺癌患者并不总是需要右半结肠切除术。阑尾切除术可能足以达到I期患者的治疗效果，但仅限于II期患者。对于晚期患者，右半结肠切除术并不优于部分结肠切除术，提示省略标准半结肠切除术可能是可行的。然而,应强烈建议进行充分的淋巴结清扫术.
