Breaking News
January 20, 2018 - Morning Break: Missing Maria Deaths; N.J. Doc Charged in Wife’s Murder; Viva Vaseline!
January 20, 2018 - No interventions proven to prevent late-life dementia
January 20, 2018 - Judge orders new Olympus trial over superbug death
January 20, 2018 - Don’t Rely on Just One Blood Pressure Test for Kids: Study
January 20, 2018 - Going Off the Deep End About Water
January 20, 2018 - Parental attention can reduce risk of drug abuse in adolescence
January 20, 2018 - Mast Uri System offers efficient and cost-friendly diagnostic solution
January 20, 2018 - International SOS, Chatham House sign partnership agreement to further advance Global Health Security Agenda
January 20, 2018 - Study offers way to predict onset of lung disease in children with cystic fibrosis
January 20, 2018 - C-Suite Must Lead in Ending Sexual Harassment
January 20, 2018 - Researchers find a way to ‘starve’ cancer
January 20, 2018 - Applied math can help predict genesis and evolution of different cancers
January 20, 2018 - UCLA researchers describe herpes virus structure associated with Kaposi’s sarcoma
January 20, 2018 - New study enrolls first patient to evaluate potential of WaveCrest LAAO System
January 20, 2018 - New review explores effects of exposing developing brains to general anesthesia
January 20, 2018 - GW Pharmaceuticals Announces Acceptance of NDA Filing for Epidiolex (cannabidiol) in the treatment of Lennox-Gastaut syndrome and Dravet syndrome
January 20, 2018 - Weight-Loss Surgery Approaches Offer Similar Results
January 20, 2018 - Free online access to millions of documents on chemical toxicity
January 20, 2018 - CE marked MAST Toxoreagent kit for detection of Toxoplasma antibodies
January 20, 2018 - DNA study sheds light on longstanding puzzle of cell division
January 20, 2018 - Montefiore provides specialized medical care to parents of adopted children
January 20, 2018 - Enzyme discovery provides new horizon of therapeutic opportunities across disease spectrum
January 20, 2018 - New smartphone app successfully enables remote monitoring of surgical wounds
January 20, 2018 - Liquid Biopsy Shows Promise for Colon Cancer
January 20, 2018 - Surgery death rates in Africa are twice global average: study
January 20, 2018 - New isothermal amplification kit using LAMP technology
January 20, 2018 - Pretreatment improves outcomes in high-risk stage 3 melanoma, study shows
January 20, 2018 - Health Highlights: Jan. 17, 2018
January 20, 2018 - House Opioid Task Force has Big Plans for 2018
January 20, 2018 - Perfectionism among young people significantly increased since 1980s, study finds
January 20, 2018 - Evidensia Sweden orders Sectra cloud-based PACS for reviewing all medical images
January 20, 2018 - Researchers test new anti-malaria medication
January 20, 2018 - Small Joint Surgeries Drop among RA Patients
January 20, 2018 - Young people with shared residency have fewer mental problems
January 20, 2018 - Childhood physical activity may have far-reaching implications
January 20, 2018 - Overweight female kidney donors of childbearing age may have greater preeclampsia risk
January 20, 2018 - MSU scientists seek to identify brain mechanisms related to psychosis
January 20, 2018 - CBT is cost-effective treatment in primary care setting, Kaiser Permanente study finds
January 20, 2018 - Scientists find how potential new eczema treatment could also alleviate asthma
January 20, 2018 - Older hospitalized patients less likely to be tested for influenza
January 20, 2018 - Syndax Pharmaceuticals Announces Clinical Collaboration to Evaluate Entinostat in Combination with anti-PD-L1 Cancer Immunotherapy in Breast Cancer
January 20, 2018 - Endoscopes Over Microscopes in Retinal Surgery: Ophthalmology Times
January 20, 2018 - Technology not taking over children’s lives despite screen-time increase
January 20, 2018 - Study finds extensive contamination around lead battery recycling plants in 7 African countries
January 20, 2018 - Flu may pass to others through exhaled breath, study shows
January 20, 2018 - Neuronal loss very limited in Alzheimer’s disease, new study shows
January 20, 2018 - Novel robot can aid treatment of rare birth defect
January 19, 2018 - TherapeuticsMD Announces Submission of New Drug Application for TX-001HR
January 19, 2018 - Fighting Infant Mortality | Medpage Today
January 19, 2018 - Researchers offer new evidence on four-year-old children’s knowledge about ecology
January 19, 2018 - Analysis finds overlooked crucial factor in determining prognosis for DIPGs
January 19, 2018 - Review explores consequences of genetic testing and cancer risk-reducing surgery
January 19, 2018 - Morning Break: HHS Div. of Religious Freedom; Trump’s Heart Health; Minister of Loneliness
January 19, 2018 - Parkinson’s disease ‘jerking’ side effect detected by algorithm
January 19, 2018 - New analysis finds dramatic increases in maternal mortality rates
January 19, 2018 - Study provides more evidence for link between increased cancer risk and advanced gum disease
January 19, 2018 - Study reveals key mechanism of how cancer metastasis happens
January 19, 2018 - Weight-Loss Surgery’s Benefits Wane Over Time for Diabetics
January 19, 2018 - Cath Lab Recap: Sapien 3 Delivery System Recall; Transatlantic PCI Smackdown
January 19, 2018 - Parkinson’s treatment could be more effective, student finds
January 19, 2018 - New vaccine approach offers effective protection against tuberculosis
January 19, 2018 - Home care agencies often wrongly deny Medicare help to the chronically ill
January 19, 2018 - One hundred percent fruit juice does not alter blood sugar levels
January 19, 2018 - Prebiotics could enhance learning and memory skills in infants
January 19, 2018 - CMS May Cover MRI With Cardiac Devices Across the Board
January 19, 2018 - As income rises, women get slimmer—but not men
January 19, 2018 - Researchers develop adhesive materials to prevent bracket stains on teeth
January 19, 2018 - Flu can be spread without coughs and sneezes
January 19, 2018 - AMSBIO’s new recombinant protein shows great promise for organoid culture
January 19, 2018 - AbbVie’s Upadacitinib Granted Breakthrough Therapy Designation from the U.S. Food and Drug Administration for Atopic Dermatitis
January 19, 2018 - ASH: Pomalidomide Dose Escalation Improves Response
January 19, 2018 - AMSBIO offers isogenic panels of neuronal iPSC derivatives
January 19, 2018 - Is your child’s school an obesity risk?
January 19, 2018 - Scientists describe groundbreaking training effect on the innate immune system
January 19, 2018 - MAST announces new AmpC, ESBL & Carbapenemase Detection Set
January 19, 2018 - Signaling molecules likely involved in concussions, rodent studies show
January 19, 2018 - Mast introduces Carba plus for CPE and OXA-48 confirmation
January 19, 2018 - Paleolithic diet helps overweight women maintain weight loss
January 19, 2018 - Agios Submits New Drug Application to the FDA for Ivosidenib for the Treatment of Patients with Relapsed/Refractory AML and an IDH1 Mutation
January 19, 2018 - This Flu Season, Don’t Forget About Tamiflu
10 MM: Better for Predicting LN Mets in Appendiceal NETs?

10 MM: Better for Predicting LN Mets in Appendiceal NETs?

image_pdfDownload PDFimage_print

Action Points

  • Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.
  • When predicting lymph node metastasis in appendiceal, well-differentiated neuroendocrine tumors (WDNETs), researchers here suggested a tumor size threshold of 10 mm compared with the traditional 20 mm.
  • Note that patients with regionally advanced well-differentiated neuroendocrine tumors have favorable prognosis regardless of type of surgery, while patients with mixed histology tumors with lymph node involvement had significantly worse survival compared to well differentiated neuroendocrine tumors.

PHILADELPHIA — When predicting lymph node metastasis in appendiceal, well-differentiated neuroendocrine tumors (WDNETs), researchers here suggested a tumor size threshold of 10 mm compared with the traditional 20 mm.

WDNETs between the size of 11 mm to 20 mm had higher rates of lymph node involvements compared to those ≤10 mm, following adequate dissection of 12 or more lymph nodes (56.8% versus 11.6%, P<0.001), according to Amir Mehrvarz Sarshekeh, MD, of the MD Anderson Cancer Center in Houston, and colleagues.

Similarly findings were reported for mixed histology tumors (MHTs) between 11-20 mm in size (32.9% versus 10.4%, P=0.004), they reported in a presentation at the North American Neuroendocrine Tumor Society annual symposium.

“Neuroendocrine tumors of appendix are usually found incidentally during appendectomy,” Mehrvarz Sarshekeh and co-author Arvind Dasari, MD, also of MD Anderson, said jointly in an email to MedPage Today. “At that time, clinicians usually face a challenge to consider appendectomy sufficient or to proceed with right hemicolectomy. The decision is usually based on the risk of regional lymph node involvement and/or metastatic disease. Tumor size is the principal factor and cut-off of 20 mm for right hemicolectomy has been accepted to formulate our treatment guidelines.

“This cut-off is based on small retrospective studies performed on carcinoid tumors of appendix,” they continued. “Since the sub-classification of appendiceal carcinoid tumors in 2010, the cut off has not been validated in different histologic subtypes and in large population-based databases. Also, the outcomes of right hemicolectomy in regionally advanced disease is unclear.”

The authors collected data on 1,731 patients from the SEER database, classified by histology codes. The analysis included 860 WDNET cases (38.0%), which mostly comprised of low-grade neuroendocrine tumors. A total of 1,659 MHT cases were assessed (60.8%) — which had tumors with both neuroendocrine and epithelial components — consisting of goblet cell carcinoid, mixed adenoneuroendocrine carcinoma, and adenocarcinoid tumors. Poorly-differentiated neuroendocrine carcinomas (PDNECs) accounted for 1.2% of appendiceal NET subtypes included (n=26).

Node-positive disease was defined in the study as any pathologic lymph node involvement, while node-negative disease was classified as no involvement after a surgical assessment of at least 12 lymph nodes. A total of 19.2% of all patients had lymph node involvement.

In a comparison of tumor subtypes, patients with WDNETs tended to be younger than those with MHT (median age 42 versus 56, P<0.001). MHT patients tended to have more distant metastases compared to WDNET cases (12.3% versus 4.8%, P<0.001).

Among the appendiceal NET histologic subtypes, 10-year cancer-specific survival rates were as follow:

  • WDNETs: 92.6%
  • MHTs: 78.1%
  • PDNECs: 0%

In an adjusted multivariable analysis, the following characteristics were significant (all P<0.001) in association with poorer cancer-specific survival in cases without any distant metastases:

  • MHT vs WDNET: HR 15.77 (95% CI 6.81-36.53)
  • Age >65 at diagnoses: HR 2.18 (95% CI 1.42-3.36)
  • Node involvement: HR 11.41 (95% CI 7.64-17.04)

However, the type of surgery — right hemicolectomy versus simple appendectomy — was not tied to cancer-specific survival (HR 1.12, 95% CI 0.72-1.73, P<0.62).

“We also observed that patients with regionally advanced well-differentiated neuroendocrine tumors have favorable prognosis regardless of type of surgery, while patients with mixed histology tumors with lymph node involvement had significantly worse survival compared to well differentiated neuroendocrine tumors,” Mehrvarz Sarshekeh and Dasari stated. “Our study confirms the findings of smaller studies with regards to risk of lymph node involvement and further builds on them by adding on the survival data.”

In terms of future research, the authors recommended studies that would confirm and validate their findings utilizing databases, and that “carefully designed prospective studies in both histological subtypes” are needed as well, they suggested.

“Also, the role of adjuvant therapy in mixed histology tumors needs to evaluated,” they said. “Until then, the need for right hemicolectomy in patients with well differentiated appendiceal neuroendocrine tumors should be personalized.”

No funding information was provided. Sarshekeh reported no relevant conflicts of interest.

  • Reviewed by
    Robert Jasmer, MD Associate Clinical Professor of Medicine, University of California, San Francisco and Dorothy Caputo, MA, BSN, RN, Nurse Planner


last updated

Tagged with:

About author

Related Articles