Medline ® Abstracts for References 19,20
of 'Cancer of the appendix and pseudomyxoma peritonei'
Novel nomogram combining depth of invasion and size can accurately predict the risk for regional nodal metastases for appendiceal neuroendocrine tumors (A-NET).
Mosquera C, Fitzgerald TL, Vora H, Grzybowski M
J Surg Oncol. 2017;116(6):651. Epub 2017 Jun 12.
INTRODUCTION: The need for regional lymphadenectomy for treating appendiceal neuroendocrine tumors (A-NET) is determined by the risk of nodal metastasis. Current guidelines for A-NET are solely based on tumor size. Methods Patients with A-NET from 1988 to 2012 were identified from the SEER registry. The depth of invasion was defined as limited to the lamina propria (LP), invading the muscularis propria (MP), and through the serosa (TS).
RESULTS: A total of 418 patients were included; the majority were female, white, and node-negative. On univariate and multivariable, the risk of nodal metastasis was associated with age, size, depth of invasion, and extent of surgery. The model predicted the likelihood of nodal metastasis, with an area under the curve of 0.89. On survival analysis, age and tumor size predicted the survival in A-NET. In a Cox regression model, they continued to predict survival. These data were utilized to create a nomogram to predict the risk of nodal metastases.
CONCLUSION: This nomogram, accurately predicts the risk ofregional nodal metastases in A-NET. In addition to providing valuable information on risk for regional nodal metastases, the depth of invasion is also predictive of survival for A-NET.
Division of Surgical Oncology, Brody School of Medicine, East Carolina University, Greenville, North Carolina.
The NANETS consensus guideline for the diagnosis and management of neuroendocrine tumors: well-differentiated neuroendocrine tumors of the Jejunum, Ileum, Appendix, and Cecum.
Boudreaux JP, Klimstra DS, Hassan MM, Woltering EA, Jensen RT, Goldsmith SJ, Nutting C, Bushnell DL, Caplin ME, Yao JC, North American Neuroendocrine Tumor Society (NANETS)
Pancreas. 2010 Aug;39(6):753-66.
Well-differentiated neuroendocrine tumors (NETs) of the jejunum, ileum, and appendix are also collectively known as midgut carcinoids. Similar to NETs in general, the diagnosed incidence of the midgut NETs is on the rise. Their presenting symptoms vary depending on stage and primary site. Local-regional NETs often present with vague and nonspecific symptoms. Classic carcinoid syndrome is more likely to appear in patients with advanced disease. Local-regional NETs of the small bowel should be resected whenever possible. With the exception of small well-differentiated NETs of the appendix, NETs of the midgut have substantial risk of relapse after resection and need to be followed for at least 7 years.Metastatic/advanced NETs of the midgut are incurable. Optimal management requires a multidisciplinary approach. Somatostatin analogs are effective in the management of carcinoid syndrome. Octreotide long-acting release has also recently been shown to delay disease progression. Liver-directed therapy and surgical debulking can improve quality of life in selected patients. Pivotal phase 3 studies with bevacizumab targeting vascular endothelial growth factor and everolimus targeting mTOR (mammalian targetof rapamycin) are ongoing and may lead to improved outcome. Further studies of novel approaches such as peptide receptor radiotherapy are also warranted.
Department of Surgery, Louisiana State University Health Sciences Center, New Orleans, LA, USA.