TY - JOUR
T1 - Morphological Factors Related to Nodal Metastases in Neuroendocrine Tumors of the Appendix
T2 - A Multicentric Retrospective Study
AU - Brighi, Nicole
AU - La Rosa, Stefano
AU - Rossi, Giulio
AU - Grillo, Federica
AU - Pusceddu, Sara
AU - Rinzivillo, Maria
AU - Spada, Francesca
AU - Tafuto, Salvatore
AU - Massironi, Sara
AU - Faggiano, Antongiulio
AU - Antonuzzo, Lorenzo
AU - Santini, Donatella
AU - Sessa, Fausto
AU - Maragliano, Roberta
AU - Gelsomino, Fabio
AU - Albertelli, Manuela
AU - Vernieri, Claudio
AU - Panzuto, Francesco
AU - Fazio, Nicola
AU - De Divitiis, Chiara
AU - Lamberti, Giuseppe
AU - Colao, Annamaria
AU - Fave, Gianfranco Delle
AU - Campana, Davide
PY - 2020/3/1
Y1 - 2020/3/1
N2 - Objective:The aim of this study was to evaluate clinical and morphological features related to nodal involvement in appendiceal neuroendocrine tumors (NETs), to identify patients who should be referred for oncological radicalization with hemicolectomy.Background:Appendiceal NETs are usually diagnosed accidentally after appendectomy; the indications for right hemicolectomy are currently based on several parameters (ie, tumor size, grading, proliferative index, localization, mesoappendiceal invasion, lymphovascular infiltration). Available guidelines are based on scarce evidence inferred by small, retrospective, single-institution studies, resulting in discordant recommendations.Methods:A retrospective analysis of a prospectively collected database was performed. Patients who underwent surgical resection of appendiceal NETs at 11 tertiary Italian centers, from January 1990 to December 2015, were included. Clinical and morphological data were analyzed to identify factors related to nodal involvement.Results:Four-hundred fifty-seven patients were evaluated, and 435 were finally included and analyzed. Of them, 21 had nodal involvement. Grading G2 [odds ratio (OR) 6.04], lymphovascular infiltration (OR 10.17), size (OR 18.50), and mesoappendiceal invasion (OR 3.63) were related to nodal disease. Receiver operating characteristic curve identified >15.5mm as the best size cutoff value (area under the curve 0.747). On multivariate analysis, grading G2 (OR 6.98), lymphovascular infiltration (OR 8.63), and size >15.5mm (OR 35.28) were independently related to nodal involvement.Conclusions:Tumor size >15.5mm, grading G2, and presence of lymphovascular infiltration are factors independently related to nodal metastases in appendiceal NETs. Presence of ≥1 of these features should be considered an indication for oncological radicalization. Although these results represent the largest study currently available, prospective validation is needed.
AB - Objective:The aim of this study was to evaluate clinical and morphological features related to nodal involvement in appendiceal neuroendocrine tumors (NETs), to identify patients who should be referred for oncological radicalization with hemicolectomy.Background:Appendiceal NETs are usually diagnosed accidentally after appendectomy; the indications for right hemicolectomy are currently based on several parameters (ie, tumor size, grading, proliferative index, localization, mesoappendiceal invasion, lymphovascular infiltration). Available guidelines are based on scarce evidence inferred by small, retrospective, single-institution studies, resulting in discordant recommendations.Methods:A retrospective analysis of a prospectively collected database was performed. Patients who underwent surgical resection of appendiceal NETs at 11 tertiary Italian centers, from January 1990 to December 2015, were included. Clinical and morphological data were analyzed to identify factors related to nodal involvement.Results:Four-hundred fifty-seven patients were evaluated, and 435 were finally included and analyzed. Of them, 21 had nodal involvement. Grading G2 [odds ratio (OR) 6.04], lymphovascular infiltration (OR 10.17), size (OR 18.50), and mesoappendiceal invasion (OR 3.63) were related to nodal disease. Receiver operating characteristic curve identified >15.5mm as the best size cutoff value (area under the curve 0.747). On multivariate analysis, grading G2 (OR 6.98), lymphovascular infiltration (OR 8.63), and size >15.5mm (OR 35.28) were independently related to nodal involvement.Conclusions:Tumor size >15.5mm, grading G2, and presence of lymphovascular infiltration are factors independently related to nodal metastases in appendiceal NETs. Presence of ≥1 of these features should be considered an indication for oncological radicalization. Although these results represent the largest study currently available, prospective validation is needed.
KW - Appendiceal
KW - carcinoid
KW - lymph nodes
KW - NET
KW - neuroendocrine neoplasms
KW - Nodal metastases
KW - prognostic factors
KW - surgery
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U2 - 10.1097/SLA.0000000000002939
DO - 10.1097/SLA.0000000000002939
M3 - Article
C2 - 29995678
AN - SCOPUS:85079878237
SN - 0003-4932
VL - 271
SP - 527
EP - 533
JO - Annals of Surgery
JF - Annals of Surgery
IS - 3
ER -