title: Clinical Significance of Metastatic Lymph Nodes in the Gut of Patients with Pure and Mixed Primary Appendiceal Carcinoids.
abstract: BACKGROUND
  Right hemicolectomy is indicated for primary appendiceal carcinoids with diameters greater than 2 cm because of an increased risk of metastasis to the lymph nodes of the gut. However, the natural history of positive nodes remains unknown.
  
  
  OBJECTIVE
  The aim of this study was to investigate the impact of metastatic lymph nodes on survival among patients with pure or mixed primary appendiceal carcinoids, while controlling for potential confounders such as age, sex, tumor size, surgical intervention, and lymph node rate (number of positive lymph nodes/lymph node yield).
  
  
  METHODS
  This is a retrospective comparative study..
  
  
  METHODS
  Data were retrieved from the Surveillance, Epidemiology and End Results database.
  
  
  METHODS
  Patients undergoing colectomy for appendiceal carcinoids between 1998 and 2009 were selected.
  
  
  METHODS
  The survival curves for the 2 groups were compared to evaluate differences in prognosis. Univariate and multivariate analyses were performed.
  
  
  RESULTS
  Lymph node rates did not significantly differ between the pure and mixed carcinoid groups (p = 0.768), although overall survival was poorer among patients with mixed carcinoids (p = 0.004; HR, 0.498; 95% CI, 0.310-0.800). For pure carcinoids, surgical intervention (p = 0.029; HR, 0.241; 95% CI, 0.067-0.867), age (p < 0.001; HR, 1.083; 95% CI, 1.051-1.116), and lymph node rate (p = 0.039; HR, 5.295; 95% CI, 1.089-25.754) were independent predictors of overall survival. For mixed carcinoids, surgical intervention (p = 0.019; HR, 1.675; 95% CI, 1.088-2.578), tumor size (p < 0.001; HR, 0.442; 95% CI, 0.286-0.683), age (p < 0.001; HR, 1.041; 95% CI, 1.026-1.056), and lymph node rate (p < 0.001; HR, 17.471; 95% CI, 10.047-0.382) were significant prognostic factors.
  
  
  CONCLUSIONS
  The study is limited by its retrospective nature and by the shortcomings of the Surveillance, Epidemiology and End Results database related to the availability and quality of data.
  
  
  CONCLUSIONS
  Based on the data retrieved from the Surveillance, Epidemiology and End Results database and adjusted for potential confounding factors, the lymph node rate of metastasis strongly impacts overall survival among patients with pure or mixed carcinoids. Nodal metastasis thus appears to be a reliable clinical hallmark of tumor aggressiveness.
authors.affiliation: 1 General and Emergency Surgery, University of L'Aquila, L'Aquila, Italy 2 Postgraduate School of Digestive Surgery, University of L'Aquila, L'Aquila, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Ciarrocchi
authors.forename: Renato
authors.initials: R
authors.lastname: Pietroletti
authors.forename: Francesco
authors.initials: F
authors.lastname: Carlei
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Amicucci
mesh_terms: D000328:Adult; D000368:Aged; D001063:Appendiceal Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D002276:Carcinoid Tumor / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D003082:Colectomy / Q000379:methods; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D018426:SEER Program; D016019:Survival Analysis