Predictors of lymph node metastases in patients with mucinous appendiceal adenocarcinoma

J Surg Oncol. 2020 Sep;122(3):399-406. doi: 10.1002/jso.25963. Epub 2020 Apr 28.


Background: Lymph node metastasis (LN+) is a prognostic factor in appendiceal cancers, but predictors and outcomes for LN+ in mucinous appendiceal adenocarcinoma (MAC) remain poorly defined.

Methods: Patients were identified from the 2010 to 2016 NCDB who underwent surgical resection as first-line management for Stage I-III mucinous appendiceal cancer. A LN+ risk-score model was developed using multivariable regression on a training data set and internally validated using a testing data set. Three-year overall survival (OS) was analyzed by Cox proportional hazards regression.

Results: Of 1158 patients, LN+ (N = 244, 21.1%) patients were more likely to have higher pT group and grade of disease, lymphovascular invasion (LVI), and positive margins on univariate analyses. Predictive factors associated with LN+ on multivariable analysis included positive surgical margins (odds ratio [OR] 3.00, P <.0001), higher grade (moderately differentiated: OR, 2.16, P < .0001; poorly or undifferentiated: OR, 3.07, P < .0001), and LVI (OR, 7.28, P < .0001). A validated risk-score model using these factors was developed with good performance (AUC 0.749). LN+ patients had a worse 3-year OS compared with LN- patients (17.4% vs 82.6%, hazard ratio 1.96, P = .001).

Conclusions: LN+ is associated with worse survival in patients with MAC. A risk-score model using margin status, LVI, and grade can accurately risk stratify patients for LN+.

Keywords: appendix cancer; lymph node harvest; lymph node metastases; positive lymph nodes; risk-score model; surgical oncology; surgical outcomes.

MeSH terms

  • Adenocarcinoma, Mucinous / mortality
  • Adenocarcinoma, Mucinous / pathology*
  • Adenocarcinoma, Mucinous / surgery
  • Appendiceal Neoplasms / mortality
  • Appendiceal Neoplasms / pathology*
  • Appendiceal Neoplasms / surgery
  • Databases, Factual
  • Female
  • Humans
  • Kaplan-Meier Estimate
  • Lymph Nodes / pathology*
  • Lymphatic Metastasis
  • Male
  • Middle Aged
  • Models, Statistical
  • Neoplasm Staging
  • Prognosis
  • Proportional Hazards Models
  • Regression Analysis
  • Retrospective Studies