[Analysis of correlation factors and risk prediction for acute appendicitis associated with appendiceal neoplasms]

Zhonghua Wai Ke Za Zhi. 2021 May 1;59(5):343-347. doi: 10.3760/cma.j.cn112139-20210129-00058.
[Article in Chinese]


Objective: To examine the correlation factors of acute appendicitis associated with appendiceal neoplasms. Methods: Consecutive 712 patients with acute appendicitis who treated at Department of General Surgery, Beijing Chaoyang Hospital, Capital Medical University from January 2002 to December 2016 were analyzed retrospectively. There were 314 females and 398 males, aging (42.5±16.2) years (range: 14 to 94 years). Among the 712 cases, 36 patients were diagnosed with acute appendicitis associated with appendiceal neoplasms, the other 676 patients had no appendiceal neoplasm. The patients' clinical baseline characteristics and clinical parameters were compared between the two groups. The correlation factors of acute appendicitis associated with appendiceal neoplasms were evaluated by using the univariate (χ2 test or t test) and multivariate Logistic regression analysis. The area under curve of receiver operating characteristic curves was utilized to evaluate the discriminatory power of the predictive models. Results: According to the univariate analysis, gender, age, body mass index, the duration of chronic right low abdominal pains≥3 months, the frequency of recurrently acute right lower abdominal pain≥2, the frequency of acute right lower abdominal pain, past history of diabetes, hypertension or coronary heart disease, the level of neutrophils and leukocytes preoperatively, stercolith and periappendiceal effusion, and modified Alvarado score were positively correlated with appendiceal neoplasms (all P<0.05). Then four variables were incorporated into the model eventually by multivariate Logistic regression analysis, which were as follows: age (increased per decade) (OR=2.23, 95%CI: 1.68 to 2.95, P<0.01), gender (female) (OR=4.21, 95%CI: 1.74 to 10.19, P=0.001), the duration of chronic right low abdominal pains (more than 3 months) (OR=2.53, 95%CI: 1.01 to 3.37, P=0.048), and modified Alvarado score (decreased per 1 score) (OR=2.54, 95%CI: 1.87 to 3.34, P<0.01). The area of curve was 0.93 (95%CI: 0.88 to 0.97), which indicated that the model exhibits an excellent ability to discriminate between appendiceal neoplasms and acute appendicitis. Conclusions: The older age, female, the duration of chronic right low abdominal pains, and lower modified Alvarado score are independent correlation factors for acute appendicitis associated with appendiceal neoplasms. Clinicians should be alert for the above clinical characteristics and choose optimal treatment for acute appendicitis associated with appendiceal neoplasms.

目的: 探讨急性阑尾炎患者合并阑尾肿瘤的相关因素。 方法: 回顾性分析首都医科大学附属北京朝阳医院2002年1月至2016年12月收治的712例急性阑尾炎病例的资料,男性398例,女性314例,年龄(42.5±16.2)岁(范围:14~94岁)。36例患者合并阑尾肿瘤,676例无阑尾肿瘤。对比两组患者的基线数据及临床指标,通过单因素分析(χ²检验或t检验)和多因素Logistic回归分析,筛选急性阑尾炎合并阑尾肿瘤的相关因素,并采用受试者工作特征曲线的曲线下面积评估模型区分能力。 结果: 单因素分析结果显示,性别、年龄、体重指数、慢性右下腹痛史(≥3个月)、反复急性右下腹痛史(≥2次)、急性右下腹痛次数,既往糖尿病、高血压或冠心病史,术前白细胞计数和中性粒细胞百分比、阑尾粪石、阑尾周围积液及改良Alvarado评分与急性阑尾炎合并阑尾肿瘤相关(P值均<0.05)。多因素分析筛选出4个变量纳入模型,分别为年龄(每增长10岁)(OR=2.23,95%CI:1.68~2.95,P<0.01)、性别(女性)(OR=4.21,95%CI:1.74~10.19,P=0.001)、慢性右下腹痛史(≥3个月)(OR=2.53,95%CI:1.01~3.37,P=0.048)和改良Alvarado评分(每减少1分)(OR=2.54,95%CI:1.87~3.34,P<0.01),该模型的曲线下面积为0.93(95%CI:0.88~0.97)。 结论: 急性阑尾炎患者年龄越大、女性、有慢性右下腹痛史和改良Alvarado评分越低是合并阑尾肿瘤的独立相关因素,对此类患者应高度警惕,术前应做好肿瘤治疗预案。.

MeSH terms

  • Acute Disease
  • Aged
  • Appendectomy
  • Appendiceal Neoplasms* / complications
  • Appendiceal Neoplasms* / epidemiology
  • Appendicitis* / complications
  • Appendicitis* / surgery
  • Female
  • Humans
  • Infant
  • Male
  • Retrospective Studies