Il Tae Son1, Soyeon Ahn2, Kyu Joo Park3, Jae Hwan Oh4, Seung-Yong Jeong3, Hyoung-Chul Park5, Seung Chul Heo6, Eui Gon Youk7, Jin-Taek Park1, Myong Hoon Ihn1, Heung-Kwon Oh1, Duck-Woo Kim1, Kyoung Ho Lee8, Sung-Bum Kang9. 1. Department of Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea. 2. Medical Research Collaborating Center, Seoul National University Bundang Hospital, Seongnam, South Korea. 3. Department of Surgery, Seoul National University Hospital, Seoul, South Korea. 4. Center for Colorectal Cancer, National Cancer Center, Goyang, South Korea. 5. Department of Surgery, Hallym University College of Medicine, Hallym University Hospital, Anyang, South Korea. 6. Department of Surgery, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, South Korea. 7. Department of Surgery, Daehang Hospital, Seoul, South Korea. 8. Department of Radiology, Seoul National University Bundang Hospital, Seongnam, South Korea. 9. Department of Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea. Electronic address: kangsb@snubh.org.
Abstract
BACKGROUND: There has been no comparative study of the long-term oncological outcomes of appendiceal cancer and colon cancer. We hypothesized that the oncological outcome is worse in appendiceal cancer because perforation is more frequent than in colon cancer. METHODS: Patients with stage I-III were selected from 5046 patients with appendiceal or colon cancer, between September 2001 and June 2010. The 5-year disease-free survival (DFS) was the primary endpoint. Multivariate analyses with Cox proportional hazards model for DFS and logistic regression model for perforation were conducted. A matching model was used to compensate for the heterogeneity between groups. RESULTS: The perforation rate was 44.7% in appendiceal cancer (n = 47), but 1.1% in colon cancer (n = 2828) (p = 0.001). The 5-year DFS rate was lower in appendiceal cancer than in colon cancer (57.9% vs. 85.2%, p = 0.001; matching model, 54.2% vs. 78.4%, p = 0.038), with a higher rate of peritoneal seeding (25.5% vs. 2.5%, p = 0.001; matching model, 24.0% vs. 4.0%, p = 0.007). Multivariate Cox regression showed that appendiceal cancer was an independent prognostic factor for poor DFS (hazard ratio = 2.602, 95% confidence interval = 1.26-5.35, p = 0.009), and logistic regression confirmed that appendiceal cancer was the risk factor associated with perforation (odds ratio = 66.265, 95% confidence interval = 28.21-155.61, p = 0.001). CONCLUSIONS: This study suggested that the long-term oncological outcomes are worse for appendiceal cancer than for colon cancer, attributed to higher perforation rate in appendiceal cancer.
BACKGROUND: There has been no comparative study of the long-term oncological outcomes of appendiceal cancer and colon cancer. We hypothesized that the oncological outcome is worse in appendiceal cancer because perforation is more frequent than in colon cancer. METHODS:Patients with stage I-III were selected from 5046 patients with appendiceal or colon cancer, between September 2001 and June 2010. The 5-year disease-free survival (DFS) was the primary endpoint. Multivariate analyses with Cox proportional hazards model for DFS and logistic regression model for perforation were conducted. A matching model was used to compensate for the heterogeneity between groups. RESULTS: The perforation rate was 44.7% in appendiceal cancer (n = 47), but 1.1% in colon cancer (n = 2828) (p = 0.001). The 5-year DFS rate was lower in appendiceal cancer than in colon cancer (57.9% vs. 85.2%, p = 0.001; matching model, 54.2% vs. 78.4%, p = 0.038), with a higher rate of peritoneal seeding (25.5% vs. 2.5%, p = 0.001; matching model, 24.0% vs. 4.0%, p = 0.007). Multivariate Cox regression showed that appendiceal cancer was an independent prognostic factor for poor DFS (hazard ratio = 2.602, 95% confidence interval = 1.26-5.35, p = 0.009), and logistic regression confirmed that appendiceal cancer was the risk factor associated with perforation (odds ratio = 66.265, 95% confidence interval = 28.21-155.61, p = 0.001). CONCLUSIONS: This study suggested that the long-term oncological outcomes are worse for appendiceal cancer than for colon cancer, attributed to higher perforation rate in appendiceal cancer.
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