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Defining a role for systemic chemotherapy in local and advanced appendix adenocarcinoma

BACKGROUND: Appendix adenocarcinomas (AAs) are rare tumours that often present late, with a propensity for peritoneal metastases (PMs). This study aimed to evaluate outcomes of AA patients undergoing cytoreductive surgery (CRS) with curative intent and determine the role of systemic chemotherapy. MA...

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Autores principales: Strach, M.C., Chakrabarty, B., Nagaraju, R.T., Mullamitha, S., Braun, M., O’Dwyer, S.T., Aziz, O., Barriuso, J.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10619141/
https://www.ncbi.nlm.nih.gov/pubmed/37625193
http://dx.doi.org/10.1016/j.esmoop.2023.101619
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author Strach, M.C.
Chakrabarty, B.
Nagaraju, R.T.
Mullamitha, S.
Braun, M.
O’Dwyer, S.T.
Aziz, O.
Barriuso, J.
author_facet Strach, M.C.
Chakrabarty, B.
Nagaraju, R.T.
Mullamitha, S.
Braun, M.
O’Dwyer, S.T.
Aziz, O.
Barriuso, J.
author_sort Strach, M.C.
collection PubMed
description BACKGROUND: Appendix adenocarcinomas (AAs) are rare tumours that often present late, with a propensity for peritoneal metastases (PMs). This study aimed to evaluate outcomes of AA patients undergoing cytoreductive surgery (CRS) with curative intent and determine the role of systemic chemotherapy. MATERIALS AND METHODS: Data were collected from a prospective database and classified according to World Health Organization (WHO) 2019 classification. Tumour clearance from CRS was described using a completeness of cytoreduction (CC) score ranging from 0 [no residual disease (RD)] to 3 (>2.5 cm RD). Patients with CC0-2 CRS received hyperthermic intraperitoneal chemotherapy (HIPEC). Systemic chemotherapy was categorised as ‘prior’ (>6 months before), ‘neoadjuvant’ (<6 months before), ‘adjuvant’ (<6 months after CC0-1 CRS) or ‘palliative’ (after CC2-3 CRS). Analyses used Kaplan–Meier and Cox regression methods. RESULTS: Between January 2005 and August 2021, 216 AA patients were identified for inclusion. Median age was 59 years (21-81 years). CRS/HIPEC was carried out in 182 (84%) patients, of whom 164/182 (76%) had mitomycin C HIPEC. CC0-1 was achieved in 172 (80%) patients. Systemic chemotherapy was given to 97 (45%) patients from the whole cohort and to 37/46 (80%) patients with positive nodes. Median overall survival (OS) was 122 months (95% confidence interval 61-182 months). After multivariate analysis, patients with acellular and lower-grade PM had similar OS to those with localised (M0) disease (P = 0.59 and P = 0.19). For patients with positive nodes, systemic chemotherapy was associated with reduced risk of death compared to no chemotherapy (P < 0.0019). CONCLUSION: This study identifies AA patients with positive lymph nodes derive the most benefit from systemic chemotherapy. We confirm the prognostic importance of stage and peritoneal grade, with excellent outcomes in patients with acellular mucin and lower-grade PM.
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spelling pubmed-106191412023-11-02 Defining a role for systemic chemotherapy in local and advanced appendix adenocarcinoma Strach, M.C. Chakrabarty, B. Nagaraju, R.T. Mullamitha, S. Braun, M. O’Dwyer, S.T. Aziz, O. Barriuso, J. ESMO Open Original Research BACKGROUND: Appendix adenocarcinomas (AAs) are rare tumours that often present late, with a propensity for peritoneal metastases (PMs). This study aimed to evaluate outcomes of AA patients undergoing cytoreductive surgery (CRS) with curative intent and determine the role of systemic chemotherapy. MATERIALS AND METHODS: Data were collected from a prospective database and classified according to World Health Organization (WHO) 2019 classification. Tumour clearance from CRS was described using a completeness of cytoreduction (CC) score ranging from 0 [no residual disease (RD)] to 3 (>2.5 cm RD). Patients with CC0-2 CRS received hyperthermic intraperitoneal chemotherapy (HIPEC). Systemic chemotherapy was categorised as ‘prior’ (>6 months before), ‘neoadjuvant’ (<6 months before), ‘adjuvant’ (<6 months after CC0-1 CRS) or ‘palliative’ (after CC2-3 CRS). Analyses used Kaplan–Meier and Cox regression methods. RESULTS: Between January 2005 and August 2021, 216 AA patients were identified for inclusion. Median age was 59 years (21-81 years). CRS/HIPEC was carried out in 182 (84%) patients, of whom 164/182 (76%) had mitomycin C HIPEC. CC0-1 was achieved in 172 (80%) patients. Systemic chemotherapy was given to 97 (45%) patients from the whole cohort and to 37/46 (80%) patients with positive nodes. Median overall survival (OS) was 122 months (95% confidence interval 61-182 months). After multivariate analysis, patients with acellular and lower-grade PM had similar OS to those with localised (M0) disease (P = 0.59 and P = 0.19). For patients with positive nodes, systemic chemotherapy was associated with reduced risk of death compared to no chemotherapy (P < 0.0019). CONCLUSION: This study identifies AA patients with positive lymph nodes derive the most benefit from systemic chemotherapy. We confirm the prognostic importance of stage and peritoneal grade, with excellent outcomes in patients with acellular mucin and lower-grade PM. Elsevier 2023-08-24 /pmc/articles/PMC10619141/ /pubmed/37625193 http://dx.doi.org/10.1016/j.esmoop.2023.101619 Text en © 2023 The Authors https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Original Research
Strach, M.C.
Chakrabarty, B.
Nagaraju, R.T.
Mullamitha, S.
Braun, M.
O’Dwyer, S.T.
Aziz, O.
Barriuso, J.
Defining a role for systemic chemotherapy in local and advanced appendix adenocarcinoma
title Defining a role for systemic chemotherapy in local and advanced appendix adenocarcinoma
title_full Defining a role for systemic chemotherapy in local and advanced appendix adenocarcinoma
title_fullStr Defining a role for systemic chemotherapy in local and advanced appendix adenocarcinoma
title_full_unstemmed Defining a role for systemic chemotherapy in local and advanced appendix adenocarcinoma
title_short Defining a role for systemic chemotherapy in local and advanced appendix adenocarcinoma
title_sort defining a role for systemic chemotherapy in local and advanced appendix adenocarcinoma
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10619141/
https://www.ncbi.nlm.nih.gov/pubmed/37625193
http://dx.doi.org/10.1016/j.esmoop.2023.101619
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