Purpose

Due to its rarity and biological heterogeneity, guidelines for primary appendiceal tumor (PAT) are based on scarce evidence, resulting in no strong recommendations. The present study explored prognosis-related factors, including the timing of lymph node dissection (LND), in PAT patients after curative resection (CR) to determine the optimal surgical therapies.

Methods

We retrospectively collected and analyzed data from 404 patients with PATs who underwent CR at 43 tertiary hospitals from 2000 to 2017. This manuscript is based on revised manuscript during review process. Please, change the bold characters to normal characters in the manuscript.

Results

After propensity score matching, there were no marked differences in the recurrence-free survival (RFS) or overall survival (OS) between the primary and secondary LND groups (P = 0.993 and 0.728). A multivariate analysis showed that lymph node metastasis (LNM) was an independent factor for the RFS (hazard ratio [HR] 2.59; 95% confidence interval [CI] 1.09–6.13; P = 0.031) and OS (HR 4.70; 95% CI 1.40–15.76; P = 0.012). There were significant associations between the LNM rates and tumor depth (P < 0.0001) and the histological type (P = 0.006). There was no LNM in patients with low-grade appendiceal mucinous neoplasm (LAMN) or well-differentiated mucinous adenocarcinoma (G1) or patients with any Tis or T1 PATs.

Conclusions

LNM was an independent prognostic predictor in PATs after CR with LND. Tumor depth and histological type were not prognostic predictors but were LNM predictors. Secondary LND based on the pathological findings of resected specimens is considered an acceptable surgical management without a worse prognosis than primary LND, and it may be omitted in LAMN+G1 or in any Tis and T1 PATs.

中文翻译：

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原发性阑尾肿瘤根治性切除后淋巴结清扫和淋巴结转移的临床意义：一项回顾性多中心队列研究

 目的

由于原发性阑尾肿瘤（PAT）的稀有性和生物异质性，其指南基于稀缺证据，因此没有强有力的建议。本研究探讨了 PAT 患者根治性切除 (CR) 后的预后相关因素，包括淋巴结清扫 (LND) 的时机，以确定最佳手术治疗。

 方法

我们回顾性收集并分析了 2000 年至 2017 年在 43 家三级医院接受 CR 的404 例PAT 患者的数据。本文基于审稿过程中的修订稿。请将稿件中的粗体字符改为普通字符。

 结果

倾向评分匹配后，原发性和继发性 LND 组之间的无复发生存期 (RFS) 或总生存期 (OS) 没有显着差异（P = 0.993和0.728 ）。多变量分析显示，淋巴结转移 (LNM) 是 RFS（风险比 [HR] 2.59 ；95% 置信区间 [CI] 1.09–6.13 ；P = 0.031 ）和 OS（HR 4.70 ；95% CI）的独立因素。 1.40–15.76 ；P = 0.012 )。 LNM 率与肿瘤深度（P < 0.0001 ）和组织学类型（P = 0.006 ）之间存在显着相关性。低度阑尾粘液性肿瘤 (LAMN) 或高分化粘液性腺癌 (G1) 患者或任何 Tis 或 T1 PAT 患者均无 LNM。

 结论

LNM 是 CR 合并 LND 后 PAT 的独立预后预测因子。肿瘤深度和组织学类型不是预后预测因素，而是 LNM 预测因素。基于切除标本病理结果的继发性 LND 被认为是可接受的手术治疗，且预后不比原发性 LND 差，并且在 LAMN+G1 或任何 Tis 和 T1 PAT 中可以省略。