Validation of the AJCC 8th Edition Staging System for Disseminated Appendiceal Cancer Patients Treated with Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy: A Multi-institutional Analysis

Gopika SenthilKumar; Anai N. Kothari; Ugwuji N. Maduekwe; Keith Fournier; Daniel E. Abbott; Gregory C. Wilson; Sameer H. Patel; Jonathan Greer; Fabian Johnston; Sean P. Dineen; Benjamin D. Powers; Joel Baumgartner; Jula Veerapong; Jennifer Leiting; Travis E. Grotz; Shishir K. Maithel; Charles Staley; Mustafa Raoof; Laura Lambert; Andrew Lee; Alex Kim; Jordan M. Cloyd; Harveshp Mogal

doi:10.1245/s10434-023-13697-9

Validation of the AJCC 8th Edition Staging System for Disseminated Appendiceal Cancer Patients Treated with Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy: A Multi-institutional Analysis

Gopika SenthilKumar, Anai N. Kothari, Ugwuji N. Maduekwe, Keith Fournier, Daniel E. Abbott, Gregory C. Wilson, Sameer H. Patel, Jonathan Greer, Fabian Johnston, Sean P. Dineen, Benjamin D. Powers, Joel Baumgartner, Jula Veerapong, Jennifer Leiting, Travis E. Grotz, Shishir K. Maithel, Charles Staley, Mustafa Raoof, Laura Lambert, Andrew LeeAlex Kim, Jordan M. Cloyd, Harveshp Mogal

Surgical Oncology

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

5 Scopus citations

Abstract

Background: The AJCC 8th edition stratifies stage IV disseminated appendiceal cancer (dAC) patients based on grade and pathology. This study was designed to externally validate the staging system and to identify predictors of long-term survival. Methods: A 12-institution cohort of dAC patients treated with CRS ± HIPEC was retrospectively analyzed. Overall survival (OS) and recurrence-free survival (RFS) were analyzed by using Kaplan-Meier and log-rank tests. Univariate and multivariate cox-regression was performed to assess factors associated with OS and RFS. Results: Among 1009 patients, 708 had stage IVA and 301 had stage IVB disease. Median OS (120.4 mo vs. 47.2 mo) and RFS (79.3 mo vs. 19.8 mo) was significantly higher in stage IVA compared with IVB patients (p < 0.0001). RFS was greater among IVA-M1a (acellular mucin only) than IV M1b/G1 (well-differentiated cellular dissemination) patients (NR vs. 64 mo, p = 0.0004). Survival significantly differed between mucinous and nonmucinous tumors (OS 106.1 mo vs. 41.0 mo; RFS 46.7 mo vs. 21.2 mo, p < 0.05), and OS differed between well, moderate, and poorly differentiated (120.4 mo vs. 56.3 mo vs. 32.9 mo, p < 0.05). Both stage and grade were independent predictors of OS and RFS on multivariate analysis. Acellular mucin and mucinous histology were associated with better OS and RFS on univariate analysis only. Conclusions: AJCC 8^th edition performed well in predicting outcomes in this large cohort of dAC patients treated with CRS ± HIPEC. Separation of stage IVA patients based on the presence of acellular mucin improved prognostication, which may inform treatment and long-term, follow-up strategies.

Original language	English (US)
Pages (from-to)	5743-5753
Number of pages	11
Journal	Annals of surgical oncology
Volume	30
Issue number	9
DOIs	https://doi.org/10.1245/s10434-023-13697-9
State	Published - Sep 2023

Keywords

AJCC 8th Edition
Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy
Disseminated appendiceal cancer

ASJC Scopus subject areas

Surgery
Oncology

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10.1245/s10434-023-13697-9

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SenthilKumar, G., Kothari, A. N., Maduekwe, U. N., Fournier, K., Abbott, D. E., Wilson, G. C., Patel, S. H., Greer, J., Johnston, F., Dineen, S. P., Powers, B. D., Baumgartner, J., Veerapong, J., Leiting, J., Grotz, T. E., Maithel, S. K., Staley, C., Raoof, M., Lambert, L., ... Mogal, H. (2023). Validation of the AJCC 8th Edition Staging System for Disseminated Appendiceal Cancer Patients Treated with Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy: A Multi-institutional Analysis. Annals of surgical oncology, 30(9), 5743-5753. https://doi.org/10.1245/s10434-023-13697-9

Validation of the AJCC 8th Edition Staging System for Disseminated Appendiceal Cancer Patients Treated with Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy: A Multi-institutional Analysis. / SenthilKumar, Gopika; Kothari, Anai N.; Maduekwe, Ugwuji N. et al.
In: Annals of surgical oncology, Vol. 30, No. 9, 09.2023, p. 5743-5753.

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

SenthilKumar, G, Kothari, AN, Maduekwe, UN, Fournier, K, Abbott, DE, Wilson, GC, Patel, SH, Greer, J, Johnston, F, Dineen, SP, Powers, BD, Baumgartner, J, Veerapong, J, Leiting, J, Grotz, TE, Maithel, SK, Staley, C, Raoof, M, Lambert, L, Lee, A, Kim, A, Cloyd, JM & Mogal, H 2023, 'Validation of the AJCC 8th Edition Staging System for Disseminated Appendiceal Cancer Patients Treated with Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy: A Multi-institutional Analysis', Annals of surgical oncology, vol. 30, no. 9, pp. 5743-5753. https://doi.org/10.1245/s10434-023-13697-9

SenthilKumar G, Kothari AN, Maduekwe UN, Fournier K, Abbott DE, Wilson GC et al. Validation of the AJCC 8th Edition Staging System for Disseminated Appendiceal Cancer Patients Treated with Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy: A Multi-institutional Analysis. Annals of surgical oncology. 2023 Sep;30(9):5743-5753. doi: 10.1245/s10434-023-13697-9

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title = "Validation of the AJCC 8th Edition Staging System for Disseminated Appendiceal Cancer Patients Treated with Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy: A Multi-institutional Analysis",

abstract = "Background: The AJCC 8th edition stratifies stage IV disseminated appendiceal cancer (dAC) patients based on grade and pathology. This study was designed to externally validate the staging system and to identify predictors of long-term survival. Methods: A 12-institution cohort of dAC patients treated with CRS ± HIPEC was retrospectively analyzed. Overall survival (OS) and recurrence-free survival (RFS) were analyzed by using Kaplan-Meier and log-rank tests. Univariate and multivariate cox-regression was performed to assess factors associated with OS and RFS. Results: Among 1009 patients, 708 had stage IVA and 301 had stage IVB disease. Median OS (120.4 mo vs. 47.2 mo) and RFS (79.3 mo vs. 19.8 mo) was significantly higher in stage IVA compared with IVB patients (p < 0.0001). RFS was greater among IVA-M1a (acellular mucin only) than IV M1b/G1 (well-differentiated cellular dissemination) patients (NR vs. 64 mo, p = 0.0004). Survival significantly differed between mucinous and nonmucinous tumors (OS 106.1 mo vs. 41.0 mo; RFS 46.7 mo vs. 21.2 mo, p < 0.05), and OS differed between well, moderate, and poorly differentiated (120.4 mo vs. 56.3 mo vs. 32.9 mo, p < 0.05). Both stage and grade were independent predictors of OS and RFS on multivariate analysis. Acellular mucin and mucinous histology were associated with better OS and RFS on univariate analysis only. Conclusions: AJCC 8th edition performed well in predicting outcomes in this large cohort of dAC patients treated with CRS ± HIPEC. Separation of stage IVA patients based on the presence of acellular mucin improved prognostication, which may inform treatment and long-term, follow-up strategies.",

keywords = "AJCC 8th Edition, Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy, Disseminated appendiceal cancer",

author = "Gopika SenthilKumar and Kothari, {Anai N.} and Maduekwe, {Ugwuji N.} and Keith Fournier and Abbott, {Daniel E.} and Wilson, {Gregory C.} and Patel, {Sameer H.} and Jonathan Greer and Fabian Johnston and Dineen, {Sean P.} and Powers, {Benjamin D.} and Joel Baumgartner and Jula Veerapong and Jennifer Leiting and Grotz, {Travis E.} and Maithel, {Shishir K.} and Charles Staley and Mustafa Raoof and Laura Lambert and Andrew Lee and Alex Kim and Cloyd, {Jordan M.} and Harveshp Mogal",

note = "Publisher Copyright: {\textcopyright} 2023, Society of Surgical Oncology.",

year = "2023",

month = sep,

doi = "10.1245/s10434-023-13697-9",

language = "English (US)",

volume = "30",

pages = "5743--5753",

journal = "Annals of surgical oncology",

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TY - JOUR

T1 - Validation of the AJCC 8th Edition Staging System for Disseminated Appendiceal Cancer Patients Treated with Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy

T2 - A Multi-institutional Analysis

AU - SenthilKumar, Gopika

AU - Kothari, Anai N.

AU - Maduekwe, Ugwuji N.

AU - Fournier, Keith

AU - Abbott, Daniel E.

AU - Wilson, Gregory C.

AU - Patel, Sameer H.

AU - Greer, Jonathan

AU - Johnston, Fabian

AU - Dineen, Sean P.

AU - Powers, Benjamin D.

AU - Baumgartner, Joel

AU - Veerapong, Jula

AU - Leiting, Jennifer

AU - Grotz, Travis E.

AU - Maithel, Shishir K.

AU - Staley, Charles

AU - Raoof, Mustafa

AU - Lambert, Laura

AU - Lee, Andrew

AU - Kim, Alex

AU - Cloyd, Jordan M.

AU - Mogal, Harveshp

PY - 2023/9

Y1 - 2023/9

N2 - Background: The AJCC 8th edition stratifies stage IV disseminated appendiceal cancer (dAC) patients based on grade and pathology. This study was designed to externally validate the staging system and to identify predictors of long-term survival. Methods: A 12-institution cohort of dAC patients treated with CRS ± HIPEC was retrospectively analyzed. Overall survival (OS) and recurrence-free survival (RFS) were analyzed by using Kaplan-Meier and log-rank tests. Univariate and multivariate cox-regression was performed to assess factors associated with OS and RFS. Results: Among 1009 patients, 708 had stage IVA and 301 had stage IVB disease. Median OS (120.4 mo vs. 47.2 mo) and RFS (79.3 mo vs. 19.8 mo) was significantly higher in stage IVA compared with IVB patients (p < 0.0001). RFS was greater among IVA-M1a (acellular mucin only) than IV M1b/G1 (well-differentiated cellular dissemination) patients (NR vs. 64 mo, p = 0.0004). Survival significantly differed between mucinous and nonmucinous tumors (OS 106.1 mo vs. 41.0 mo; RFS 46.7 mo vs. 21.2 mo, p < 0.05), and OS differed between well, moderate, and poorly differentiated (120.4 mo vs. 56.3 mo vs. 32.9 mo, p < 0.05). Both stage and grade were independent predictors of OS and RFS on multivariate analysis. Acellular mucin and mucinous histology were associated with better OS and RFS on univariate analysis only. Conclusions: AJCC 8th edition performed well in predicting outcomes in this large cohort of dAC patients treated with CRS ± HIPEC. Separation of stage IVA patients based on the presence of acellular mucin improved prognostication, which may inform treatment and long-term, follow-up strategies.

AB - Background: The AJCC 8th edition stratifies stage IV disseminated appendiceal cancer (dAC) patients based on grade and pathology. This study was designed to externally validate the staging system and to identify predictors of long-term survival. Methods: A 12-institution cohort of dAC patients treated with CRS ± HIPEC was retrospectively analyzed. Overall survival (OS) and recurrence-free survival (RFS) were analyzed by using Kaplan-Meier and log-rank tests. Univariate and multivariate cox-regression was performed to assess factors associated with OS and RFS. Results: Among 1009 patients, 708 had stage IVA and 301 had stage IVB disease. Median OS (120.4 mo vs. 47.2 mo) and RFS (79.3 mo vs. 19.8 mo) was significantly higher in stage IVA compared with IVB patients (p < 0.0001). RFS was greater among IVA-M1a (acellular mucin only) than IV M1b/G1 (well-differentiated cellular dissemination) patients (NR vs. 64 mo, p = 0.0004). Survival significantly differed between mucinous and nonmucinous tumors (OS 106.1 mo vs. 41.0 mo; RFS 46.7 mo vs. 21.2 mo, p < 0.05), and OS differed between well, moderate, and poorly differentiated (120.4 mo vs. 56.3 mo vs. 32.9 mo, p < 0.05). Both stage and grade were independent predictors of OS and RFS on multivariate analysis. Acellular mucin and mucinous histology were associated with better OS and RFS on univariate analysis only. Conclusions: AJCC 8th edition performed well in predicting outcomes in this large cohort of dAC patients treated with CRS ± HIPEC. Separation of stage IVA patients based on the presence of acellular mucin improved prognostication, which may inform treatment and long-term, follow-up strategies.

KW - AJCC 8th Edition

KW - Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy

KW - Disseminated appendiceal cancer

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Validation of the AJCC 8th Edition Staging System for Disseminated Appendiceal Cancer Patients Treated with Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy: A Multi-institutional Analysis

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