• J. Gastrointest. Surg. · Jan 2020

    Multicenter Study

    Should We Be Doing Cytoreductive Surgery with HIPEC for Signet Ring Cell Appendiceal Adenocarcinoma? A Study from the US HIPEC Collaborative.

    • Nick C Levinsky, Mackenzie C Morris, Koffi Wima, Jeffrey J Sussman, Syed A Ahmad, Jordan M Cloyd, Charles Kimbrough, Keith Fournier, Andrew Lee, Sean Dineen, Sophie Dessureault, Jula Veerapong, Joel M Baumgartner, Callisia Clarke, Mohammad Y Zaidi, Charles A Staley, Shishir K Maithel, Jennifer Leiting, Travis Grotz, Laura Lambert, Ryan J Hendrix, Sean Ronnekleiv-Kelly, Courtney Pokrzywa, Mustafa Raoof, Oliver S Eng, Fabian M Johnston, Jonathan Greer, and Sameer H Patel.
    • Division of Surgical Oncology, Department of Surgery, University of Cincinnati College of Medicine, 231 Albert Sabin Way ML-0558, Cincinnati, OH, 45267-0558, USA.
    • J. Gastrointest. Surg. 2020 Jan 1; 24 (1): 155-164.

    BackgroundAppendiceal adenocarcinoma with signet ring cells (SCA) is associated with worse overall survival (OS), and it is unclear whether cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) should be pursued in this patient population. We assessed the prognostic implications of signet ring cells in patients with appendiceal adenocarcinoma and peritoneal carcinomatosis undergoing CRS-HIPEC.MethodsThe US HIPEC Collaborative, a 12-center, multi-institutional database of patients undergoing CRS-HIPEC, was reviewed for patients with SCA. Univariate and multivariate analyses were performed.ResultsOf 514 patients undergoing CRS-HIPEC for appendiceal adenocarcinoma, 125 (24%) had SCA. The SCA and non-SCA groups had similar baseline characteristics. SCA had worse OS compared with non-SCA (32.0 vs 91.4 months, p < 0.001). In univariate analysis for only SCA cases, there was worse OS in patients with poorly differentiated tumors, positive lymph nodes, LVI, PCI > 20, or incomplete cytoreduction (CC-2/3). However, multivariate analysis showed only positive lymph nodes (HR 1.14 [95% CI 1.00-1.31], p = 0.04), poor differentiation (5.60 [1.29-24.39], p = 0.02), and incomplete cytoreduction (4.90 [1.11-12.70], p = 0.03) were independently associated with decreased OS for SCA.ConclusionWhile signet cells are a negative prognostic feature, they should not be a contraindication to CRS-HIPEC in patients with well-moderately differentiated tumors with negative lymph nodes, where complete cytoreduction can be achieved.

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