title: Lymph Node Metastasis Predicts Disease Recurrence in a Single-Center Experience of 70 Stages 1-3 Appendix Cancers: A Retrospective Review.
abstract: BACKGROUND
  Previous reports on the surgical management of appendix cancer show high recurrence rates among patients initially presenting with localized disease. This study sought to characterize predictors of outcome among patients treated for stages 1-3 appendix cancer at the authors' institution.
  
  
  METHODS
  Patients with nonmetastatic appendix cancer undergoing definitive surgery at a single cancer center from 1994 to 2013 were retrospectively reviewed. Patients with appendiceal adenomas, cystadenomas, or classical carcinoids were excluded from the study. The median follow-up period was 5.2 years (interquartile range 2.9-6.7 years).
  
  
  RESULTS
  The study identified 70 patients, 49 % of whom were women. The median age was 52 years (range 20-84 years). All were explored by an expert surgeon who had treated at least 20 appendiceal cancers. The procedures were appendectomy (n = 2), right hemicolectomy (n = 66), and diagnostic laparoscopy and placement of an intraperitoneal port (n = 2). The final pathology showed that transmural (30 T4, 32 T3, 4 T2, 4 T1) and node-negative disease (80 %) were common. Goblet cell carcinoid (GCC) features were identified in 54 % of the tumors. These were smaller and more likely to present as acute appendicitis than appendiceal adenocarcinoma (AA), but were otherwise similar in clinical presentation and outcome. The presence of lymph node (LN) metastasis was associated with a higher risk of recurrence than of stage 2 appendix cancer (78 vs. 4 % at 5 years; p < 0.0001). A total of 12 patients experienced recurrence (5 GCC, 7 AA): 9 in the peritoneum, 2 in mesenteric LNs, and 1 in the surgical incision.
  
  
  CONCLUSIONS
  Stages 1-3 invasive AA and GCC behave similarly in terms of clinical presentation and outcome. Perforated appendix and T4 tumor stage were common but not associated with recurrence. Although uncommon, LN metastasis strongly predicted recurrence.
authors: Colorectal Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA. nashg@mskcc.org.
authors: Garrett M
authors: GM
authors: Nash
authors: Colorectal Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
authors: James D
authors: JD
authors: Smith
authors: Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
authors: Laura
authors: L
authors: Tang
authors: Colorectal Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
authors: Martin R
authors: MR
authors: Weiser
authors: Colorectal Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
authors: Larissa K
authors: LK
authors: Temple
authors: Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
authors: Eileen
authors: E
authors: O'Reilly
authors: Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
authors: Leonard B
authors: LB
authors: Saltz
authors: Colorectal Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
authors: José G
authors: JG
authors: Guillem
authors: Colorectal Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
authors: Philip B
authors: PB
authors: Paty
mesh_terms: D000230:Adenocarcinoma / Q000556:secondary / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001062:Appendectomy; D001063:Appendiceal Neoplasms / Q000473:pathology* / Q000601:surgery*; D002276:Carcinoid Tumor / Q000556:secondary / Q000601:surgery*; D003082:Colectomy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008643:Mesentery; D008875:Middle Aged; D009366:Neoplasm Seeding; D009367:Neoplasm Staging; D010534:Peritoneal Neoplasms / Q000556:secondary*; D011379:Prognosis; D012189:Retrospective Studies; D055815:Young Adult