Analysis of prognostic factors in patients with appendiceal adenocarcinoma and construction of a predictive model: based on SEER Database_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

ZHAO Haoyong , DONG Haifeng , GAO Fei ,  HAN Bin

Department of General Surgery, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou 450003, P. R. China;

Corresponding author：

HAN Bin, Email: 13303862545@163.com

Keywords：

appendiceal adenocarcinoma; SEER database; prediction model; overall survival; cancer-specific survival

DOI：

10.7507/1007-9424.202503079

Video：

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Objective To analyze the risk factors affecting prognosis of appendiceal adenocarcinoma using data from the Surveillance, Epidemiology, and End Results (SEER) database. Methods The patients pathologically diagnosed with appendiceal adenocarcinoma from 2005 to 2015 were extracted from the SEER database and then randomly divided into a training cohort and validation cohort at a 7∶3 ratio. The univariate and multivariate Cox regression analyses were performed in the training cohort to identify the independent risk factors for overall survival (OS) and cancer-specific survival (CSS). Based on these factors, a nomogram prediction model was constructed and subsequently validated. Results A total of 749 patients with appendiceal adenocarcinoma were enrolled, with 524 in the training cohort and 225 in the validation cohort. The multivariate Cox regression analysis identified that the T, N, M stages, and surgery as the independent prognostic factors for both OS and CSS. Additionally, the age and tumor size were the independent prognostic factors for OS and CSS, respectively. Based on these factors, the nomogram prediction models for OS and CSS were constructed. The C-index (95%CI) of the OS nomogram prediction model was 0.716 (0.689, 0.743) in the training cohort and 0.695 (0.649, 0.740) in the validation cohort. The C-index of the CSS nomogram prediction model was 0.749 (0.716, 0.782) and 0.746 (0.699, 0.793) in the training and validation cohorts, respectively. The calibration curves demonstrated a good agreement between predicted and observed outcomes for both OS and CSS. The area under the receiver operating characteristic curve (AUC) of the OS nomogram prediction model in predicting 3- and 5-year overall survival rate was 0.780 (0.739, 0.821) and 0.773 (0.732, 0.814) respectively in the training cohort, was 0.789 (0.726, 0.852) and 0.776(0.715, 0.837) respectively in the validation cohort. The AUC of the CSS nomogram prediction model in predicting 3- and 5-year cancer-specific survival rate was 0.813 (0.768, 0.858) and 0.796 (0.753, 0.839) respectively in the training cohort, was 0.813 (0.750, 0.876)and 0.811 (.750, 0.872) respectively in the validation cohort. Conclusions Through analysis of appendiceal adenocarcinoma patients from the SEER database reveals that advanced T, N, and M stages, as well as lack of surgery are significant risk factors for both OS and CSS. The constructed nomogram prediction models for OS and CSS, incorporating these risk factors, has a good prediction ability.

1.	Wang Y, Geng Y, Hu W. Survival and prognostic factors for postoperative primary appendiceal cancer: a retrospective cohort study based on the Surveillance, Epidemiology, and End Results database. J Gastrointest Oncol, 2022, 13(3): 1433-1443.
2.	Murphy EM, Farquharson SM, Moran BJ. Management of an unexpected appendiceal neoplasm. Br J Surg, 2006, 93(7): 783-792.
3.	Shang J, Ruan LT, Dang Y, et al. Contrast-enhanced ultrasound improves accurate identification of appendiceal mucinous adenocarcinoma in an old patient: A case report. Medicine (Baltimore), 2016, 95(35): e4637. doi: 10.1097/MD.0000000000004637.
4.	Guraya SY, Almaramhy HH. Clinicopathological features and the outcome of surgical management for adenocarcinoma of the appendix. World J Gastrointest Surg, 2011, 3(1): 7-12.
5.	Carr NJ, Bibeau F, Bradley RF, et al. The histopathological classification, diagnosis and differential diagnosis of mucinous appendiceal neoplasms, appendiceal adenocarcinomas and pseudomyxoma peritonei. Histopathology, 2017, 71(6): 847-858.
6.	Boudreaux JP, Klimstra DS, Hassan MM, et al. The NANETS consensus guideline for the diagnosis and management of neuroendocrine tumors: Well-differentiated neuroendocrine tumors of the jejunum, ileum, appendix, and cecum. Pancreas, 2010, 39(6): 753-766.
7.	AlMasri SS, Hammad AY, Singhi AD, et al. Appendectomy is oncologically equivalent to right hemicolectomy for well-differentiated T1 appendiceal adenocarcinoma. Dis Colon Rectum, 2023, 66(1): 67-74.
8.	Shannon AB, Goldberg D, Song Y, et al. Predictors of lymph node metastases in patients with mucinous appendiceal adenocarcinoma. J Surg Oncol, 2020, 122(3): 399-406.
9.	Hata K, Tanaka N, Nomura Y, et al. Early appendiceal adenocarcinoma. A review of the literature with special reference to optimal surgical procedures. J Gastroenterol, 2002, 37(3): 210-214.
10.	Glasgow SC, Gaertner W, Stewart D, et al. The American Society of colon and rectal surgeons, clinical practice guidelines for the management of appendiceal neoplasms. Dis Colon Rectum, 2019, 62(12): 1425-1438.
11.	Gahagan JV, Whealon MD, Phelan MJ, et al. Lymph node positivity in appendiceal adenocarcinoma: Should size matter?. J Am Coll Surg, 2017, 225(1): 69-75.
12.	Orr CE, Yantiss RK. Controversies in appendiceal pathology: mucinous and goblet cell neoplasms. Pathology, 2022, 54(2): 167-176.
13.	Xu W, Jia S, Zhang Y, et al. Prognostic nomograms for patients undergoing radical operation for stage Ⅰ–Ⅲ appendiceal adenocarcinoma: A surveillance, epidemiology, and end results database analysis. J Cancer Res Ther, 2021, 17(7): 1656-1664.
14.	Asare EA, Compton CC, Hanna NN, et al. The impact of stage, grade, and mucinous histology on the efficacy of systemic chemotherapy in adenocarcinomas of the appendix: Analysis of the National Cancer Data Base. Cancer, 2016, 122(2): 213-221.
15.	AlMasri SS, Paniccia A, Hammad AY, et al. The role of adjuvant chemotherapy following right hemicolectomy for non-metastatic mucinous and nonmucinous appendiceal adenocarcinoma. J Gastrointest Surg, 2022, 26(1): 171-180.
16.	Yan Q, Zheng WJ, Chen QL, et al. Nomogram to predict overall survival and disease-specific survival with appendiceal mucinous adenocarcinoma. Medicine (Baltimore), 2019, 98(40): e17332. doi: 10.1097/MD.0000000000017332.
17.	Xie X, Zhou Z, Song Y, et al. The management and prognostic prediction of adenocarcinoma of appendix. Sci Rep, 2016, 6: 39027. doi: 10.1038/srep39027.
18.	Pham TH, Wolff B, Abraham SC, et al. Surgical and chemotherapy treatment outcomes of goblet cell carcinoid: a tertiary cancer center experience. Ann Surg Oncol, 2006, 13(3): 370-376.
19.	曾海伦, 刘星, 唐宇飞, 等. 结肠癌相关性调节性B细胞介导淋巴管生成的体外研究. 中国肿瘤临床, 2023, 50(5): 232-236.

1. Wang Y, Geng Y, Hu W. Survival and prognostic factors for postoperative primary appendiceal cancer: a retrospective cohort study based on the Surveillance, Epidemiology, and End Results database. J Gastrointest Oncol, 2022, 13(3): 1433-1443.
2. Murphy EM, Farquharson SM, Moran BJ. Management of an unexpected appendiceal neoplasm. Br J Surg, 2006, 93(7): 783-792.
3. Shang J, Ruan LT, Dang Y, et al. Contrast-enhanced ultrasound improves accurate identification of appendiceal mucinous adenocarcinoma in an old patient: A case report. Medicine (Baltimore), 2016, 95(35): e4637. doi: 10.1097/MD.0000000000004637.
4. Guraya SY, Almaramhy HH. Clinicopathological features and the outcome of surgical management for adenocarcinoma of the appendix. World J Gastrointest Surg, 2011, 3(1): 7-12.
5. Carr NJ, Bibeau F, Bradley RF, et al. The histopathological classification, diagnosis and differential diagnosis of mucinous appendiceal neoplasms, appendiceal adenocarcinomas and pseudomyxoma peritonei. Histopathology, 2017, 71(6): 847-858.
6. Boudreaux JP, Klimstra DS, Hassan MM, et al. The NANETS consensus guideline for the diagnosis and management of neuroendocrine tumors: Well-differentiated neuroendocrine tumors of the jejunum, ileum, appendix, and cecum. Pancreas, 2010, 39(6): 753-766.
7. AlMasri SS, Hammad AY, Singhi AD, et al. Appendectomy is oncologically equivalent to right hemicolectomy for well-differentiated T1 appendiceal adenocarcinoma. Dis Colon Rectum, 2023, 66(1): 67-74.
8. Shannon AB, Goldberg D, Song Y, et al. Predictors of lymph node metastases in patients with mucinous appendiceal adenocarcinoma. J Surg Oncol, 2020, 122(3): 399-406.
9. Hata K, Tanaka N, Nomura Y, et al. Early appendiceal adenocarcinoma. A review of the literature with special reference to optimal surgical procedures. J Gastroenterol, 2002, 37(3): 210-214.
10. Glasgow SC, Gaertner W, Stewart D, et al. The American Society of colon and rectal surgeons, clinical practice guidelines for the management of appendiceal neoplasms. Dis Colon Rectum, 2019, 62(12): 1425-1438.
11. Gahagan JV, Whealon MD, Phelan MJ, et al. Lymph node positivity in appendiceal adenocarcinoma: Should size matter?. J Am Coll Surg, 2017, 225(1): 69-75.
12. Orr CE, Yantiss RK. Controversies in appendiceal pathology: mucinous and goblet cell neoplasms. Pathology, 2022, 54(2): 167-176.
13. Xu W, Jia S, Zhang Y, et al. Prognostic nomograms for patients undergoing radical operation for stage Ⅰ–Ⅲ appendiceal adenocarcinoma: A surveillance, epidemiology, and end results database analysis. J Cancer Res Ther, 2021, 17(7): 1656-1664.
14. Asare EA, Compton CC, Hanna NN, et al. The impact of stage, grade, and mucinous histology on the efficacy of systemic chemotherapy in adenocarcinomas of the appendix: Analysis of the National Cancer Data Base. Cancer, 2016, 122(2): 213-221.
15. AlMasri SS, Paniccia A, Hammad AY, et al. The role of adjuvant chemotherapy following right hemicolectomy for non-metastatic mucinous and nonmucinous appendiceal adenocarcinoma. J Gastrointest Surg, 2022, 26(1): 171-180.
16. Yan Q, Zheng WJ, Chen QL, et al. Nomogram to predict overall survival and disease-specific survival with appendiceal mucinous adenocarcinoma. Medicine (Baltimore), 2019, 98(40): e17332. doi: 10.1097/MD.0000000000017332.
17. Xie X, Zhou Z, Song Y, et al. The management and prognostic prediction of adenocarcinoma of appendix. Sci Rep, 2016, 6: 39027. doi: 10.1038/srep39027.
18. Pham TH, Wolff B, Abraham SC, et al. Surgical and chemotherapy treatment outcomes of goblet cell carcinoid: a tertiary cancer center experience. Ann Surg Oncol, 2006, 13(3): 370-376.
19. 曾海伦, 刘星, 唐宇飞, 等. 结肠癌相关性调节性B细胞介导淋巴管生成的体外研究. 中国肿瘤临床, 2023, 50(5): 232-236.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Latest ArticlesAnalysis of prognostic factors in patients with appendiceal adenocarcinoma and construction of a predictive model: based on SEER Database

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