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Session: ePoster: Colon and Colorectal Cancer 3 (Sun1230)

EP428 - Lymph Node Harvest Mediates Survival in Patients with Locally Advanced Appendiceal Adenocarcinoma

Sunday, May 11, 2025
12:57 PM – 1:02 PM PT
Location: Monitor 4, Sails Pavilion, Upper Level

    ePoster Presenter(s)

  • George Q. Zhang, MD MPH

    Resident
    Brigham and Women's Hospital
    Boston, MA, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

    • Author(s)

  • Leonardo Garcia, MD

    Colon and Rectal Surgery Fellow
    Brigham and Women's Hospital
    The Johns Hopkins Hospital
    Chestnut Hill, MA, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

  • Nelya Melnitchouk, MD

    Assistant Professor
    Brigham and Women's Hospital
    Harvard Medical School
    Boston, Massachusetts, United States

    Disclosure information not submitted.

  • Ronald Bleday, M.D.

    Chief of Colorectal Surgery
    Brigham and Woman's Hospital
    Boston, Massachusetts, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

  • Jennifer Irani, MD

    Assistant Professor of Surgery
    Brigham and Women's Hospital
    Boston, Massachusetts, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

    • Senior Author(s)

  • JG

    Joel E. Goldberg, MD MPH

    Colorectal Surgeon
    Brigham and Women's Hospital
    Boston, Massachusetts, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

All of the relevant financial relationships listed below have been mitigated.
George Q. Zhang, MD MPH: This individual has no financial relationships with ineligible companies.
Leonardo Garcia, MD: This individual has no financial relationships with ineligible companies.
Ronald Bleday, M.D.: This individual has no financial relationships with ineligible companies.
Jennifer Irani, MD: This individual has no financial relationships with ineligible companies.
Joel E. Goldberg, MD MPH: This individual has no financial relationships with ineligible companies.
Image or Table (Do Not add text here):

Purpose/Background: Lymph node (LN) metastasis is a negative prognostic factor in appendiceal adenocarcinoma. Current parameters surrounding adequate LN harvest are extrapolated from standards for colorectal cancer that are very defined as to who benefits from adjuvant therapy. Guidelines specific to appendiceal cancer remain limited. This study aimed to determine the impact of LN harvest on 1) overall survival and 2) survival benefit incurred from adjuvant therapy among all patients with locally advanced appendiceal adenocarcinoma, as well as 3) survival benefit incurred from adjuvant therapy among patients with high-risk histologic features.

Methods/Interventions: The National Cancer Database was queried for all adult patients diagnosed with Stage II or III appendiceal adenocarcinoma between the years 2004-2018 and subsequently underwent surgical resection. The primary outcome was 5-year overall survival (OS). Univariate (Kaplan-Meier estimate) and multivariable (Cox proportional hazard model) survival analyses were used to assess OS. Interaction effects were used to determine the relationship of LN harvest and response to adjuvant chemotherapy.

Results/Outcomes: A cohort of 7,414 patients with appendiceal adenocarcinoma were included. Those with pN0 disease were stratified by number of regional LNs evaluated on pathology (0-11 nodes, N=1,214, 12-23 nodes, N=2,595, ≥24 nodes, N=1,114). Patients with node-positive disease (N=2,491) were also included. Five-year OS among all pN0 patients was 79.8%. Mortality decreased with increasing LN harvest (ptrend < 0.001; Figure) among node-negative patients. This finding persisted on adjusted analysis (0-11 nodes, reference; 12-23 nodes, adjusted hazard ratio (aHR)=0.70, 95% confidence interval [0.61, 0.80]; ≥24 nodes, aHR=0.50 [0.41, 0.61]). As expected, patients with node-positive disease had worse outcomes (aHR=2.10 [1.86, 2.38]). LN harvest did not alter the impact of adjuvant chemotherapy on OS among all patients with pN0 disease (pinteraction > 0.05 for all groups). However, in a subset with lymphovascular invasion (LVI), patients with 0-11 LN harvested at surgery demonstrated a survival benefit with chemotherapy. Conversely, adequately staged patients with LVI did not benefit from chemotherapy (0-11 nodes, reference; ≥24 nodes, aHRinteraction=4.03, pinteraction=0.027). Neither patients with T4 stage or high grade tumors benefited from chemotherapy regardless of LN harvest (pinteraction>0.05 for both).

Conclusion/Discussion: Investigation of more LNs is associated with a survival benefit in patients with pN0 locally advanced appendiceal adenocarcinoma. Furthermore, adjuvant chemotherapy in pN0 disease yielded no differential in survival regardless of LN harvest, except among those with LVI and inadequate staging. Adequate lymphadenectomy is important to accurately risk stratify patients with locally advanced appendiceal adenocarcinoma.