Do Lymph Node Metastases Matter in Appendiceal Cancer with Peritoneal Carcinomatosis? A US HIPEC Collaborative Study

Kevin M. Turner; Mackenzie C. Morris; Aaron M. Delman; Dennis Hanseman; Fabian M. Johnston; Jonathan Greer; Kara Vande Walle; Daniel E. Abbott; Mustafa Raoof; Travis E. Grotz; Keith Fournier; Sean Dineen; Jula Veerapong; Ugwuji Maduekwe; Anai Kothari; Charles A. Staley; Shishir K. Maithel; Laura A. Lambert; Alex C. Kim; Jordan M. Cloyd; Gregory C. Wilson; Jeffrey J. Sussman; Syed A. Ahmad; Sameer H. Patel

doi:10.1007/s11605-022-05489-5

Do Lymph Node Metastases Matter in Appendiceal Cancer with Peritoneal Carcinomatosis? A US HIPEC Collaborative Study

Kevin M. Turner, Mackenzie C. Morris, Aaron M. Delman, Dennis Hanseman, Fabian M. Johnston, Jonathan Greer, Kara Vande Walle, Daniel E. Abbott, Mustafa Raoof, Travis E. Grotz, Keith Fournier, Sean Dineen, Jula Veerapong, Ugwuji Maduekwe, Anai Kothari, Charles A. Staley, Shishir K. Maithel, Laura A. Lambert, Alex C. Kim, Jordan M. CloydGregory C. Wilson, Jeffrey J. Sussman, Syed A. Ahmad, Sameer H. Patel

Surgical Oncology

Research output: Contribution to journal › Article › peer-review

2 Scopus citations

Abstract

Background: Whether formal regional lymph node (LN) evaluation is necessary for patients with appendiceal adenocarcinoma (AA) who have peritoneal metastases is unclear. The aim of this study was to evaluate the prognostic value of LN metastases on survival in patients treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC). Methods: A retrospective analysis of the US HIPEC collaborative, a multi-institutional consortium comprising 12 high-volume centers, was performed to identify patients with AA who underwent CRS-HIPEC with adequate LN sampling (≥ 12 LNs). Results: Two hundred-fifty patients with AA who underwent CRS-HIPEC were included. Outcomes were compared between LN − and LN + disease. Baseline patient characteristics between groups were similar, with most patients undergoing complete cytoreduction (0/1: 86.0% vs. 76.8%, p = 0.08), respectively. More adverse tumor factors were found in patients with LN + disease, including poor differentiation, signet ring cells, and lymphovascular invasion. Multivariate analysis of overall survival (OS) found LN + disease was independently associated with worse OS (HR: 2.82 95%CI: 1.25–6.34, p = 0.01), even after correction for receipt of 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). LN + disease remained associated with poor OS following propensity score matching (HR: 4.98 95%CI: 1.72–14.40, p < 0.01) and in patients with PCI ≥ 20 (HR: 3.68 95%CI: 1.54–8.80, p < 0.01). Conclusions: In this large multi-institutional study of patients with AA undergoing CRS-HIPEC, LN status remained associated with worse OS even in the setting of advanced peritoneal carcinomatosis. Formal LN evaluation should be performed for most patients with AA undergoing CRS-HIPEC.

Original language	English (US)
Pages (from-to)	2569-2578
Number of pages	10
Journal	Journal of Gastrointestinal Surgery
Volume	26
Issue number	12
DOIs	https://doi.org/10.1007/s11605-022-05489-5
State	Published - Dec 2022

Keywords

Appendiceal adenocarcinoma
Cytoreductive surgery
HIPEC
Lymph node metastases

ASJC Scopus subject areas

Surgery
Gastroenterology

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10.1007/s11605-022-05489-5

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Turner, K. M., Morris, M. C., Delman, A. M., Hanseman, D., Johnston, F. M., Greer, J., Walle, K. V., Abbott, D. E., Raoof, M., Grotz, T. E., Fournier, K., Dineen, S., Veerapong, J., Maduekwe, U., Kothari, A., Staley, C. A., Maithel, S. K., Lambert, L. A., Kim, A. C., ... Patel, S. H. (2022). Do Lymph Node Metastases Matter in Appendiceal Cancer with Peritoneal Carcinomatosis? A US HIPEC Collaborative Study. Journal of Gastrointestinal Surgery, 26(12), 2569-2578. https://doi.org/10.1007/s11605-022-05489-5

Turner, KM, Morris, MC, Delman, AM, Hanseman, D, Johnston, FM, Greer, J, Walle, KV, Abbott, DE, Raoof, M, Grotz, TE, Fournier, K, Dineen, S, Veerapong, J, Maduekwe, U, Kothari, A, Staley, CA, Maithel, SK, Lambert, LA, Kim, AC, Cloyd, JM, Wilson, GC, Sussman, JJ, Ahmad, SA & Patel, SH 2022, 'Do Lymph Node Metastases Matter in Appendiceal Cancer with Peritoneal Carcinomatosis? A US HIPEC Collaborative Study', Journal of Gastrointestinal Surgery, vol. 26, no. 12, pp. 2569-2578. https://doi.org/10.1007/s11605-022-05489-5

@article{66ed08253dd24d8cba785da72e90cd7b,

title = "Do Lymph Node Metastases Matter in Appendiceal Cancer with Peritoneal Carcinomatosis? A US HIPEC Collaborative Study",

abstract = "Background: Whether formal regional lymph node (LN) evaluation is necessary for patients with appendiceal adenocarcinoma (AA) who have peritoneal metastases is unclear. The aim of this study was to evaluate the prognostic value of LN metastases on survival in patients treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC). Methods: A retrospective analysis of the US HIPEC collaborative, a multi-institutional consortium comprising 12 high-volume centers, was performed to identify patients with AA who underwent CRS-HIPEC with adequate LN sampling (≥ 12 LNs). Results: Two hundred-fifty patients with AA who underwent CRS-HIPEC were included. Outcomes were compared between LN − and LN + disease. Baseline patient characteristics between groups were similar, with most patients undergoing complete cytoreduction (0/1: 86.0% vs. 76.8%, p = 0.08), respectively. More adverse tumor factors were found in patients with LN + disease, including poor differentiation, signet ring cells, and lymphovascular invasion. Multivariate analysis of overall survival (OS) found LN + disease was independently associated with worse OS (HR: 2.82 95%CI: 1.25–6.34, p = 0.01), even after correction for receipt of 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). LN + disease remained associated with poor OS following propensity score matching (HR: 4.98 95%CI: 1.72–14.40, p < 0.01) and in patients with PCI ≥ 20 (HR: 3.68 95%CI: 1.54–8.80, p < 0.01). Conclusions: In this large multi-institutional study of patients with AA undergoing CRS-HIPEC, LN status remained associated with worse OS even in the setting of advanced peritoneal carcinomatosis. Formal LN evaluation should be performed for most patients with AA undergoing CRS-HIPEC.",

keywords = "Appendiceal adenocarcinoma, Cytoreductive surgery, HIPEC, Lymph node metastases",

author = "Turner, {Kevin M.} and Morris, {Mackenzie C.} and Delman, {Aaron M.} and Dennis Hanseman and Johnston, {Fabian M.} and Jonathan Greer and Walle, {Kara Vande} and Abbott, {Daniel E.} and Mustafa Raoof and Grotz, {Travis E.} and Keith Fournier and Sean Dineen and Jula Veerapong and Ugwuji Maduekwe and Anai Kothari and Staley, {Charles A.} and Maithel, {Shishir K.} and Lambert, {Laura A.} and Kim, {Alex C.} and Cloyd, {Jordan M.} and Wilson, {Gregory C.} and Sussman, {Jeffrey J.} and Ahmad, {Syed A.} and Patel, {Sameer H.}",

note = "Publisher Copyright: {\textcopyright} 2022, The Society for Surgery of the Alimentary Tract.",

year = "2022",

month = dec,

doi = "10.1007/s11605-022-05489-5",

language = "English (US)",

volume = "26",

pages = "2569--2578",

journal = "Journal of Gastrointestinal Surgery",

issn = "1091-255X",

publisher = "Springer New York",

number = "12",

}

TY - JOUR

T1 - Do Lymph Node Metastases Matter in Appendiceal Cancer with Peritoneal Carcinomatosis? A US HIPEC Collaborative Study

AU - Turner, Kevin M.

AU - Morris, Mackenzie C.

AU - Delman, Aaron M.

AU - Hanseman, Dennis

AU - Johnston, Fabian M.

AU - Greer, Jonathan

AU - Walle, Kara Vande

AU - Abbott, Daniel E.

AU - Raoof, Mustafa

AU - Grotz, Travis E.

AU - Fournier, Keith

AU - Dineen, Sean

AU - Veerapong, Jula

AU - Maduekwe, Ugwuji

AU - Kothari, Anai

AU - Staley, Charles A.

AU - Maithel, Shishir K.

AU - Lambert, Laura A.

AU - Kim, Alex C.

AU - Cloyd, Jordan M.

AU - Wilson, Gregory C.

AU - Sussman, Jeffrey J.

AU - Ahmad, Syed A.

AU - Patel, Sameer H.

PY - 2022/12

Y1 - 2022/12

N2 - Background: Whether formal regional lymph node (LN) evaluation is necessary for patients with appendiceal adenocarcinoma (AA) who have peritoneal metastases is unclear. The aim of this study was to evaluate the prognostic value of LN metastases on survival in patients treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC). Methods: A retrospective analysis of the US HIPEC collaborative, a multi-institutional consortium comprising 12 high-volume centers, was performed to identify patients with AA who underwent CRS-HIPEC with adequate LN sampling (≥ 12 LNs). Results: Two hundred-fifty patients with AA who underwent CRS-HIPEC were included. Outcomes were compared between LN − and LN + disease. Baseline patient characteristics between groups were similar, with most patients undergoing complete cytoreduction (0/1: 86.0% vs. 76.8%, p = 0.08), respectively. More adverse tumor factors were found in patients with LN + disease, including poor differentiation, signet ring cells, and lymphovascular invasion. Multivariate analysis of overall survival (OS) found LN + disease was independently associated with worse OS (HR: 2.82 95%CI: 1.25–6.34, p = 0.01), even after correction for receipt of 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). LN + disease remained associated with poor OS following propensity score matching (HR: 4.98 95%CI: 1.72–14.40, p < 0.01) and in patients with PCI ≥ 20 (HR: 3.68 95%CI: 1.54–8.80, p < 0.01). Conclusions: In this large multi-institutional study of patients with AA undergoing CRS-HIPEC, LN status remained associated with worse OS even in the setting of advanced peritoneal carcinomatosis. Formal LN evaluation should be performed for most patients with AA undergoing CRS-HIPEC.

AB - Background: Whether formal regional lymph node (LN) evaluation is necessary for patients with appendiceal adenocarcinoma (AA) who have peritoneal metastases is unclear. The aim of this study was to evaluate the prognostic value of LN metastases on survival in patients treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC). Methods: A retrospective analysis of the US HIPEC collaborative, a multi-institutional consortium comprising 12 high-volume centers, was performed to identify patients with AA who underwent CRS-HIPEC with adequate LN sampling (≥ 12 LNs). Results: Two hundred-fifty patients with AA who underwent CRS-HIPEC were included. Outcomes were compared between LN − and LN + disease. Baseline patient characteristics between groups were similar, with most patients undergoing complete cytoreduction (0/1: 86.0% vs. 76.8%, p = 0.08), respectively. More adverse tumor factors were found in patients with LN + disease, including poor differentiation, signet ring cells, and lymphovascular invasion. Multivariate analysis of overall survival (OS) found LN + disease was independently associated with worse OS (HR: 2.82 95%CI: 1.25–6.34, p = 0.01), even after correction for receipt of 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). LN + disease remained associated with poor OS following propensity score matching (HR: 4.98 95%CI: 1.72–14.40, p < 0.01) and in patients with PCI ≥ 20 (HR: 3.68 95%CI: 1.54–8.80, p < 0.01). Conclusions: In this large multi-institutional study of patients with AA undergoing CRS-HIPEC, LN status remained associated with worse OS even in the setting of advanced peritoneal carcinomatosis. Formal LN evaluation should be performed for most patients with AA undergoing CRS-HIPEC.

KW - Appendiceal adenocarcinoma

KW - Cytoreductive surgery

KW - HIPEC

KW - Lymph node metastases

UR - http://www.scopus.com/inward/record.url?scp=85140101531&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85140101531&partnerID=8YFLogxK

U2 - 10.1007/s11605-022-05489-5

DO - 10.1007/s11605-022-05489-5

M3 - Article

C2 - 36258061

AN - SCOPUS:85140101531

SN - 1091-255X

VL - 26

SP - 2569

EP - 2578

JO - Journal of Gastrointestinal Surgery

JF - Journal of Gastrointestinal Surgery

IS - 12

ER -

Do Lymph Node Metastases Matter in Appendiceal Cancer with Peritoneal Carcinomatosis? A US HIPEC Collaborative Study

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