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Regional lymph node involvement and outcomes in appendiceal neuroendocrine tumors: a SEER database analysis

BACKGROUND: Appendiceal neuroendocrine neoplasms are most often diagnosed incidentally during appendectomy. The need for subsequent right hemicolectomy (RHC) is determined based on the risk of regional lymph node (LN) involvement. Tumor size has historically been used as an indicator of this risk, b...

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Autores principales: Mehrvarz Sarshekeh, Amir, Advani, Shailesh, Halperin, Daniel M., Conrad, Claudius, Shen, Chan, Yao, James C., Dasari, Arvind
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Impact Journals LLC 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5725113/
https://www.ncbi.nlm.nih.gov/pubmed/29245922
http://dx.doi.org/10.18632/oncotarget.20362
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author Mehrvarz Sarshekeh, Amir
Advani, Shailesh
Halperin, Daniel M.
Conrad, Claudius
Shen, Chan
Yao, James C.
Dasari, Arvind
author_facet Mehrvarz Sarshekeh, Amir
Advani, Shailesh
Halperin, Daniel M.
Conrad, Claudius
Shen, Chan
Yao, James C.
Dasari, Arvind
author_sort Mehrvarz Sarshekeh, Amir
collection PubMed
description BACKGROUND: Appendiceal neuroendocrine neoplasms are most often diagnosed incidentally during appendectomy. The need for subsequent right hemicolectomy (RHC) is determined based on the risk of regional lymph node (LN) involvement. Tumor size has historically been used as an indicator of this risk, but controversy remains regarding its cut off. Furthermore, the impact of RHC on survival is unclear. METHODS: We used the SEER database to identify patients diagnosed with appendiceal neuroendocrine tumors. RESULTS: Of 1731 patients, 38.0% had well-differentiated neuroendocrine tumors (WDNETs), 60.8% had mixed histology tumors (MHTs), and 1.2% had poorly differentiated neuroendocrine carcinomas (PDNECs). In patients with WDNETs and MHTs who had adequate lymphadenectomy, higher rates of LN involvement were noted for tumors size 11–20 mm than ≤10 mm (56.8% vs. 11.6%, p <0.001; 32.9% vs. 10.4%, p=0.004, respectively). The type of surgery did not affect OS in cases with MHTs with LN involvement (HR 1.00; 95% CI, 0.53–1.89; p =0.99). Patients with regionally advanced WDNET showed excellent survival and only 3 patients (out of 118) died from cancer within 10 years. CONCLUSIONS: 10 mm appears to be a more appropriate cutoff than 20 mm for predicting LN metastasis in appendiceal NETs. Cases with WDNETs and nodal involvement demonstrate overall excellent prognosis irrespective of type of surgery (i.e. RHC may not improve outcome). In MHTs with LN metastases, survival is markedly worse in spite of RHC. The role of adjuvant therapy should be evaluated in this subset.
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spelling pubmed-57251132017-12-14 Regional lymph node involvement and outcomes in appendiceal neuroendocrine tumors: a SEER database analysis Mehrvarz Sarshekeh, Amir Advani, Shailesh Halperin, Daniel M. Conrad, Claudius Shen, Chan Yao, James C. Dasari, Arvind Oncotarget Research Paper BACKGROUND: Appendiceal neuroendocrine neoplasms are most often diagnosed incidentally during appendectomy. The need for subsequent right hemicolectomy (RHC) is determined based on the risk of regional lymph node (LN) involvement. Tumor size has historically been used as an indicator of this risk, but controversy remains regarding its cut off. Furthermore, the impact of RHC on survival is unclear. METHODS: We used the SEER database to identify patients diagnosed with appendiceal neuroendocrine tumors. RESULTS: Of 1731 patients, 38.0% had well-differentiated neuroendocrine tumors (WDNETs), 60.8% had mixed histology tumors (MHTs), and 1.2% had poorly differentiated neuroendocrine carcinomas (PDNECs). In patients with WDNETs and MHTs who had adequate lymphadenectomy, higher rates of LN involvement were noted for tumors size 11–20 mm than ≤10 mm (56.8% vs. 11.6%, p <0.001; 32.9% vs. 10.4%, p=0.004, respectively). The type of surgery did not affect OS in cases with MHTs with LN involvement (HR 1.00; 95% CI, 0.53–1.89; p =0.99). Patients with regionally advanced WDNET showed excellent survival and only 3 patients (out of 118) died from cancer within 10 years. CONCLUSIONS: 10 mm appears to be a more appropriate cutoff than 20 mm for predicting LN metastasis in appendiceal NETs. Cases with WDNETs and nodal involvement demonstrate overall excellent prognosis irrespective of type of surgery (i.e. RHC may not improve outcome). In MHTs with LN metastases, survival is markedly worse in spite of RHC. The role of adjuvant therapy should be evaluated in this subset. Impact Journals LLC 2017-08-19 /pmc/articles/PMC5725113/ /pubmed/29245922 http://dx.doi.org/10.18632/oncotarget.20362 Text en Copyright: © 2017 Mehrvarz Sarshekeh et al. http://creativecommons.org/licenses/by/3.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0/) 3.0 (CC BY 3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Paper
Mehrvarz Sarshekeh, Amir
Advani, Shailesh
Halperin, Daniel M.
Conrad, Claudius
Shen, Chan
Yao, James C.
Dasari, Arvind
Regional lymph node involvement and outcomes in appendiceal neuroendocrine tumors: a SEER database analysis
title Regional lymph node involvement and outcomes in appendiceal neuroendocrine tumors: a SEER database analysis
title_full Regional lymph node involvement and outcomes in appendiceal neuroendocrine tumors: a SEER database analysis
title_fullStr Regional lymph node involvement and outcomes in appendiceal neuroendocrine tumors: a SEER database analysis
title_full_unstemmed Regional lymph node involvement and outcomes in appendiceal neuroendocrine tumors: a SEER database analysis
title_short Regional lymph node involvement and outcomes in appendiceal neuroendocrine tumors: a SEER database analysis
title_sort regional lymph node involvement and outcomes in appendiceal neuroendocrine tumors: a seer database analysis
topic Research Paper
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5725113/
https://www.ncbi.nlm.nih.gov/pubmed/29245922
http://dx.doi.org/10.18632/oncotarget.20362
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