Resident University of Cincinnati Cincinnati, Massachusetts, United States
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
Participants should be aware of the following financial/non-financial relationships:
Kevin M. Turner, MD: I do not have any relevant financial / non-financial relationships with any proprietary interests.
Introduction: The regional lymph node (LN) status of patients with appendiceal adenocarcinoma (AA) who have peritoneal metastases is unknown. The aim of this study was to evaluate the prognostic value of LN metastasis on survival in patients treated with cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC).
Methods: A retrospective analysis of the US HIPEC collaborative, a multi-institutional consortium comprising 12 high-volume centers, was performed for patients with AA. Patients who underwent CRS-HIPEC with adequate LN sampling (≥12 LNs) were included.
Results: 250 patients with AA who underwent CRS-HIPEC met inclusion criteria, with outcomes compared between LN positive (LN+) and LN negative (LN-) disease. Baseline patient characteristics between cohorts were similar, including peritoneal cancer index (PCI). The majority of patients in both cohorts underwent complete cytoreduction (CCR) (0/1) (83.4% and 82.4%, respectively). More adverse tumor factors were found in patients with LN+ disease, including poor differentiation, signet ring cells, and lymphovascular and perineural invasion. The LN+ group were more likely to receive systemic therapy (56.5% vs. 22.7, p< 0.01). Multivariate analysis of overall survival (OS) found positive nodal status was independently associated with decreased OS (HR: 4.87 95% CI: 2.01-12.00, p< 0.01), even after correcting for systemic therapy. On Kaplan-Meier analysis, median OS was lower in patients with LN+ disease (25.9 months vs. 91.4 months, p< 0.01).(Figure 1) LN+ disease remained associated with reduced OS in the 39 pairs identified by propensity score matching on key clinicopathologic features, including PCI and CCR. When limited to the cohort with PCI≥20, LN+ continued to be associated with poor OS (22.8 months vs. 73.3 months, p< 0.01).
Conclusions: In this large multi-institutional study of patients with AA undergoing CRS-HIPEC, lymph node status remained independently associated with survival even in the setting of advanced peritoneal dissemination. Formal lymph node evaluation should still be performed for patients with AA undergoing CRS-HIPEC.
Learning Objectives:
understand the prognostic impact of LN status in patients with appendiceal adenocarcinoma who have peritoneal metastases.
understand how the poor prognosis associated with LN positivity is independent of key clfinicopathologic features, such as PCI and CCR.
describe the impact of LN status in the cohort of patients with PCI>20.
