Adenocarcinoma Ex-Goblet Cell: A Retrospective Experience

J Gastrointest Cancer. 2019 Dec;50(4):709-715. doi: 10.1007/s12029-018-0131-2.

Abstract

Purpose: Adenocarcinoma ex-goblet cell carcinoids (AGCCs) are rare appendiceal tumors with mixed neuroendocrine and glandular features. They tend to behave more aggressively than typical carcinoid tumors, affect younger patients, and have a greater predilection for spreading to the peritoneum. Outcomes of AGCC patients treated with chemotherapy, extrapolated from colon cancer regimens, in the adjuvant or metastatic setting have not been explicitly reported. We sought to explore outcomes of AGCC patients with either local disease treated with adjuvant FOLFOX or metastatic disease treated with FOLFOX/FOLFIRI post-cytoreductive debulking (or CRS plus HIPEC in the peritoneal-limited setting).

Methods: We performed a single-institution retrospective analysis of 23 pathologically identified AGCC patients from Vanderbilt University Medical Center treated with chemotherapy in either the adjuvant or metastatic settings. Each patient's tumor was categorized as group B or group C based on the criteria from Tang et al. Median progression-free survival (PFS) or disease-free survival (DFS) (in the curative setting) and overall survival (OS) were determined for each patient and specified patient subgroup.

Results and conclusion: AGCC patients who were treated with FOLFOX chemotherapy in the adjuvant setting or FOLFOX/FOLFIRI in the metastatic setting experienced prolonged PFS, DFS, and OS. Five patients with peritoneal-limited disease treated with CRS plus HIPEC have not yet reached median PFS or OS. While small sample size, patient selection, and retrospective nature limit the generalizability of findings from our analysis, the efficacy signals we observed suggest prospective evaluation with chemotherapy and CRS plus HIPEC is warranted in AGCC patients.

Keywords: Adenocarcinoma ex-goblet cell; Appendiceal tumor; Chemotherapy; HIPEC.

MeSH terms

  • Antineoplastic Combined Chemotherapy Protocols / administration & dosage
  • Appendiceal Neoplasms / mortality
  • Appendiceal Neoplasms / pathology
  • Appendiceal Neoplasms / therapy*
  • Camptothecin / administration & dosage
  • Camptothecin / analogs & derivatives
  • Carcinoid Tumor / mortality
  • Carcinoid Tumor / secondary
  • Carcinoid Tumor / therapy*
  • Chemotherapy, Adjuvant / methods
  • Cytoreduction Surgical Procedures*
  • Disease-Free Survival
  • Female
  • Fluorouracil / administration & dosage
  • Follow-Up Studies
  • Goblet Cells / pathology
  • Humans
  • Hyperthermia, Induced / methods*
  • Leucovorin / administration & dosage
  • Male
  • Middle Aged
  • Organoplatinum Compounds / administration & dosage
  • Peritoneal Neoplasms / mortality
  • Peritoneal Neoplasms / secondary
  • Peritoneal Neoplasms / therapy*
  • Progression-Free Survival
  • Retrospective Studies

Substances

  • Organoplatinum Compounds
  • Leucovorin
  • Fluorouracil
  • Camptothecin

Supplementary concepts

  • Folfox protocol
  • IFL protocol