Nicole Brighi1, Stefano La Rosa2, Giulio Rossi3, Federica Grillo4, Sara Pusceddu5, Maria Rinzivillo6, Francesca Spada7, Salvatore Tafuto8, Sara Massironi9, Antongiulio Faggiano10, Lorenzo Antonuzzo11, Donatella Santini12, Fausto Sessa13, Roberta Maragliano13, Fabio Gelsomino14, Manuela Albertelli15, Claudio Vernieri5, Francesco Panzuto6, Nicola Fazio7, Chiara De Divitiis8, Giuseppe Lamberti1, Annamaria Colao10, Gianfranco Delle Fave6, Davide Campana16. 1. Department of Experimental, Diagnostic and Specialty Medicine, S.Orsola-Malpighi University Hospital, Bologna, Italy. 2. Service of Clinical Pathology, Lausanne University Hospital, Institute of Pathology, Lausanne, Switzerland. 3. Pathology Unit, Azienda Romagna, Ospedale S. Maria delle Croci, Ravenna, Italy. 4. Department of Surgical Science and Integrated Diagnostics (DISC), Pathology Unit, University of Genoa, Genoa, Italy. 5. Department of Medical Oncology, ENETS Center of Excellence, Fondazione IRCCS Istituto dei Tumori, Milan, Italy. 6. Digestive and Liver Disease Unit, Sant'Andrea Hospital Sapienza University of Rome, Roma, Italy. 7. Unit of Gastrointestinal Medical Oncology and Neuroendocrine Tumors, European Institute of Oncology, IEO, Milan, Italy. 8. Abdominal Oncology, Istituto Nazionale per lo Studio e la Cura dei Tumori - IRCCS Naples "Fondazione G. Pascale", Naples, Italy. 9. Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy. 10. Department of Clinical Medicine and Surgery, Division of Endocrinology, University Federico II of Naples, Napoli, Italy. 11. S.C. Oncologia Medica 1, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy. 12. Department of Diagnostic and Prevention Medicine, S.Orsola-Malpighi University Hospital, Bologna, Italy. 13. Department of Medicine and Surgery, University of Insubria, Varese, Italy. 14. Department of Oncology and Haematology, Division of Oncology, University Hospital of Modena, Modena, Italy. 15. Endocrinology, Department of Internal Medicine and Medical Specialties (DIMI)University of Genoa, Genoa, Italy. 16. Department of Medical and Surgical Sciences, S.Orsola-Malpighi University Hospital, Bologna, Italy.
Abstract
OBJECTIVE: The aim of this study was to evaluate clinical and morphological features related to nodal involvement in appendiceal neuroendocrine tumors (NETs), to identify patients who should be referred for oncological radicalization with hemicolectomy. BACKGROUND: Appendiceal NETs are usually diagnosed accidentally after appendectomy; the indications for right hemicolectomy are currently based on several parameters (ie, tumor size, grading, proliferative index, localization, mesoappendiceal invasion, lymphovascular infiltration). Available guidelines are based on scarce evidence inferred by small, retrospective, single-institution studies, resulting in discordant recommendations. METHODS: A retrospective analysis of a prospectively collected database was performed. Patients who underwent surgical resection of appendiceal NETs at 11 tertiary Italian centers, from January 1990 to December 2015, were included. Clinical and morphological data were analyzed to identify factors related to nodal involvement. RESULTS: Four-hundred fifty-seven patients were evaluated, and 435 were finally included and analyzed. Of them, 21 had nodal involvement. Grading G2 [odds ratio (OR) 6.04], lymphovascular infiltration (OR 10.17), size (OR 18.50), and mesoappendiceal invasion (OR 3.63) were related to nodal disease. Receiver operating characteristic curve identified >15.5 mm as the best size cutoff value (area under the curve 0.747). On multivariate analysis, grading G2 (OR 6.98), lymphovascular infiltration (OR 8.63), and size >15.5 mm (OR 35.28) were independently related to nodal involvement. CONCLUSIONS: Tumor size >15.5 mm, grading G2, and presence of lymphovascular infiltration are factors independently related to nodal metastases in appendiceal NETs. Presence of ≥1 of these features should be considered an indication for oncological radicalization. Although these results represent the largest study currently available, prospective validation is needed.
OBJECTIVE: The aim of this study was to evaluate clinical and morphological features related to nodal involvement in appendiceal neuroendocrine tumors (NETs), to identify patients who should be referred for oncological radicalization with hemicolectomy. BACKGROUND:Appendiceal NETs are usually diagnosed accidentally after appendectomy; the indications for right hemicolectomy are currently based on several parameters (ie, tumor size, grading, proliferative index, localization, mesoappendiceal invasion, lymphovascular infiltration). Available guidelines are based on scarce evidence inferred by small, retrospective, single-institution studies, resulting in discordant recommendations. METHODS: A retrospective analysis of a prospectively collected database was performed. Patients who underwent surgical resection of appendiceal NETs at 11 tertiary Italian centers, from January 1990 to December 2015, were included. Clinical and morphological data were analyzed to identify factors related to nodal involvement. RESULTS: Four-hundred fifty-seven patients were evaluated, and 435 were finally included and analyzed. Of them, 21 had nodal involvement. Grading G2 [odds ratio (OR) 6.04], lymphovascular infiltration (OR 10.17), size (OR 18.50), and mesoappendiceal invasion (OR 3.63) were related to nodal disease. Receiver operating characteristic curve identified >15.5 mm as the best size cutoff value (area under the curve 0.747). On multivariate analysis, grading G2 (OR 6.98), lymphovascular infiltration (OR 8.63), and size >15.5 mm (OR 35.28) were independently related to nodal involvement. CONCLUSIONS:Tumor size >15.5 mm, grading G2, and presence of lymphovascular infiltration are factors independently related to nodal metastases in appendiceal NETs. Presence of ≥1 of these features should be considered an indication for oncological radicalization. Although these results represent the largest study currently available, prospective validation is needed.
Authors: José Luis Muñoz de Nova; Jorge Hernando; Miguel Sampedro Núñez; Greissy Tibisay Vázquez Benítez; Eva María Triviño Ibáñez; María Isabel Del Olmo García; Jorge Barriuso; Jaume Capdevila; Elena Martín-Pérez Journal: World J Gastroenterol Date: 2022-04-07 Impact factor: 5.374
Authors: Maria Rinzivillo; Francesco Panzuto; Gianluca Esposito; Edith Lahner; Alberto Signore; Bruno Annibale Journal: J Clin Med Date: 2022-03-16 Impact factor: 4.241