Abstract：
BACKGROUND: The presence of lymph node (LN) metastasis is a known negative prognostic factor in appendix cancer (AC) patients. However, currently the minimum number of LNs required to adequately determine LN negativity is extrapolated from colorectal studies and data specific to AC is lacking. We aimed to define the lowest number of LNs required to adequately stage AC and assess its impact on oncologic outcomes.
METHODS: Patients with stage II-III AC from the National Cancer Database (NCDB 2004-2019) undergoing surgical resection with complete information about LN examination were included. Multivariable logistic regression assessed the odds of LN positive (LNP) disease for different numbers of LNs examined. Multivariable Cox regressions were performed by LN status subgroups, adjusted by prognostic factors, including grade, histologic subtype, surgical approach, and documented adjuvant systemic chemotherapy.
RESULTS: Overall, 3,602 patients were included, from which 1,026 (28.5%) were LNP. Harvesting ten LNs was the minimum number required without decreased odds of LNP compared with the reference category (≥ 20 LNs). Total LNs examined were < 10 in 466 (12.9%) patients. Median follow-up from diagnosis was 75.4 months. Failing to evaluate at least ten LNs was an independent negative prognostic factor for overall survival (adjusted hazard ratio 1.39, p < 0.01).
CONCLUSIONS: In appendix adenocarcinoma, examining a minimum of ten LNs was necessary to minimize the risk of missing LNP disease and was associated with improved overall survival rates. To mitigate the risk of misclassification, an adequate number of regional LNs must be assessed to determine LN status.
METHODS: Patients with stage II-III AC from the National Cancer Database (NCDB 2004-2019) undergoing surgical resection with complete information about LN examination were included. Multivariable logistic regression assessed the odds of LN positive (LNP) disease for different numbers of LNs examined. Multivariable Cox regressions were performed by LN status subgroups, adjusted by prognostic factors, including grade, histologic subtype, surgical approach, and documented adjuvant systemic chemotherapy.
RESULTS: Overall, 3,602 patients were included, from which 1,026 (28.5%) were LNP. Harvesting ten LNs was the minimum number required without decreased odds of LNP compared with the reference category (≥ 20 LNs). Total LNs examined were < 10 in 466 (12.9%) patients. Median follow-up from diagnosis was 75.4 months. Failing to evaluate at least ten LNs was an independent negative prognostic factor for overall survival (adjusted hazard ratio 1.39, p < 0.01).
CONCLUSIONS: In appendix adenocarcinoma, examining a minimum of ten LNs was necessary to minimize the risk of missing LNP disease and was associated with improved overall survival rates. To mitigate the risk of misclassification, an adequate number of regional LNs must be assessed to determine LN status.
摘要：
背景：在阑尾癌（AC）患者中，淋巴结（LN）转移的存在是已知的负预后因素。然而,目前,充分确定LN阴性所需的最小LN数量是从结直肠研究中推断出来的,并且缺乏针对AC的特定数据.我们旨在确定充分分期AC所需的最低LN数量，并评估其对肿瘤学结局的影响。
方法：国家癌症数据库（NCDB2004-2019）中II-III期AC患者接受手术切除，并提供有关LN检查的完整信息。多变量逻辑回归评估了不同数量的LN检查的LN阳性（LNP）疾病的几率。多变量Cox回归由LN状态亚组进行，根据预后因素进行调整，包括等级,组织学亚型，手术方法,并记录了辅助全身化疗。
结果：总体而言，纳入了3,602名患者，其中1,026人（28.5%）为LNP。与参考类别（≥20个LN）相比，收获10个LN是所需的最低数量，而不会降低LNP的几率。466例(12.9%)患者中检查的总LN<10。从诊断开始的中位随访时间为75.4个月。未能评估至少10个LN是总生存期的独立阴性预后因素（校正后的风险比1.39，p<0.01）。
结论：在阑尾腺癌中，检查至少10个LN是必要的,以最大限度地降低LNP疾病缺失的风险,并且与改善的总体生存率相关.为了减轻错误分类的风险，必须评估足够数量的区域LN，以确定LN状态。
方法：国家癌症数据库（NCDB2004-2019）中II-III期AC患者接受手术切除，并提供有关LN检查的完整信息。多变量逻辑回归评估了不同数量的LN检查的LN阳性（LNP）疾病的几率。多变量Cox回归由LN状态亚组进行，根据预后因素进行调整，包括等级,组织学亚型，手术方法,并记录了辅助全身化疗。
结果：总体而言，纳入了3,602名患者，其中1,026人（28.5%）为LNP。与参考类别（≥20个LN）相比，收获10个LN是所需的最低数量，而不会降低LNP的几率。466例(12.9%)患者中检查的总LN<10。从诊断开始的中位随访时间为75.4个月。未能评估至少10个LN是总生存期的独立阴性预后因素（校正后的风险比1.39，p<0.01）。
结论：在阑尾腺癌中，检查至少10个LN是必要的,以最大限度地降低LNP疾病缺失的风险,并且与改善的总体生存率相关.为了减轻错误分类的风险，必须评估足够数量的区域LN，以确定LN状态。
