Abstract
Context .- The prognosis of appendiceal goblet cell carcinoid tumors (GCTs) is believed to be intermediate between appendiceal adenocarcinomas and conventional carcinoid tumors. However, GCTs can have mixed morphologic patterns, with variable amount of adenocarcinoma. Objective .- To evaluate the behavior of GCTs and related entities with variable components of adenocarcinoma. Design .- We classified 74 cases of appendiceal tumors into 3 groups: group 1, GCTs or GCTs with less than 25% adenocarcinoma; group 2, GCTs with 25% to 50% adenocarcinoma; group 3, GCTs with more than 50% adenocarcinoma; and a comparison group of 68 adenocarcinomas without a GCT component (group 4). Well-differentiated mucinous adenocarcinomas were excluded. Clinicopathologic features and follow-up were obtained from computerized medical records and the US Social Security Death Index. Results .- Of the 142 tumors studied, 23 tumors (16%) were classified as group 1; 27 (19%) as group 2; 24 (17%) as group 3; and 68 (48%) as group 4. Staging and survival differed significantly among these groups. Among 140 patients (99%) with available staging data, stages II, III, and IV were present in 87%, 4%, and 4% of patients in group 1 patients; 67%, 7%, and 22% of patients in group 2; 29%, 4%, and 67% of patients in group 3; and 19%, 6%, and 75% of patients in group 4, respectively (P = .01). Mean (SD) overall survival was 83.8 (34.6), 60.6 (30.3), 45.6 (39.7), and 33.6 (27.6) months for groups 1, 2, 3, and 4, respectively (P = .01). By multivariate analysis, only stage and tumor category were independent predictors of overall survival. Conclusion .- Our data highlight the importance of subclassifying the proportion of adenocarcinoma in appendiceal tumors with GCT morphology because that finding reflects disease stage and affects survival.
摘要
背景:据信,阑尾杯状细胞类癌(GCT)的预后处于阑尾腺癌和普通类癌之间。然而,GCT可以含有混合性的形态学类型,伴有多少不等的腺癌成分。目的:评估GCT以及伴有不同腺癌成分的相关肿瘤生物学行为。设计:我们将74例阑尾肿瘤分为3组:第1组,GCT或GCT伴有的腺癌成分少于25%;第2组,GCT伴有的腺癌成分为25%-50%;第3组,GCT伴有的腺癌成分超过50%;无GCT成分的68例腺癌作为对照组(第4组)。高分化黏液性腺癌不纳入研究范围。临床病理学特征及随访资料从电子病历和美国社会保障死亡索引中获取。结果:我们所研究的142例肿瘤各自分组如下:第1组23例(16%)、第2组27例(19%)、第3组24例(17%)、第4组68例(48%)。这些组间的分期和存活率明显不同。在可获取分期数据的140例(99%)患者中,II期、III期和IV期在第1组患者中所占比例分别为87%、4%和4%、第2组分别为67%、7%和22%、第3组分别为29%、4%和67%、第4组分别为19%、6%和75%(P=0.01)。第1、2、3、4组四组总体平均生存期(SD)分别为83.8(34.6)、 60.6(30.3)、 45.6 (39.7)和 33.6 (27.6)个月(P=0.01)。多变量分析显示,只有分期和肿瘤分类为总体生存期的独立预后因素。结论:我们的数据突显了对伴GCT形态的阑尾肿瘤中腺癌部分进行亚分类的重要性,因为这一结果影响肿瘤分期及患者生存期。
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