Impact of adjuvant chemotherapy on outcomes in appendiceal cancer

Bhaskar C Kolla; Ashley Petersen; Madhuri Chengappa; Tulasi Gummadi; Chitra Ganesan; Wolfgang B Gaertner; Anne Blaes

doi:10.1002/cam4.3009

Impact of adjuvant chemotherapy on outcomes in appendiceal cancer

Cancer Med. 2020 May;9(10):3400-3406. doi: 10.1002/cam4.3009. Epub 2020 Mar 19.

Authors

Bhaskar C Kolla¹, Ashley Petersen², Madhuri Chengappa³, Tulasi Gummadi³, Chitra Ganesan³, Wolfgang B Gaertner⁴, Anne Blaes¹

Affiliations

¹ Division of Hematology, Oncology and Transplantation, University of Minnesota, Minneapolis, MN, USA.
² Division of Biostatistics, University of Minnesota, Minneapolis, MN, USA.
³ Department of Medicine, University of Minnesota, Minneapolis, MN, USA.
⁴ Department of Surgery, University of Minnesota, Minneapolis, MN, USA.

Abstract

Background: The impact of using adjuvant chemotherapy following cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) in patients with appendiceal adenocarcinoma is not known. The aim of this study was to assess the impact of adjuvant chemotherapy following complete cytoreduction in patients with appendiceal adenocarcinoma.

Methods: Retrospective medical record review of all patients with appendiceal adenocarcinoma treated at our institution between 2006 and 2015. Kaplan-Meier plots were used to summarize overall survival (OS) and relapse-free survival over time, and log-rank tests and Cox proportional hazards models were used to test for differences in survival between groups.

Results: A total of 103 patients with appendiceal adenocarcinoma received care at our institution during the study period. Complete cytoreduction (cytoreductive score 0-1) was achieved in 68 patients (66%). Of these 68 patients, 26 received adjuvant chemotherapy. The most common regimens were capecitabine (n = 11), capecitabine plus oxaliplatin (n = 7), and 5-FU plus oxaliplatin (n = 6). Tumor histopathology and grade, and the ability to achieve complete cytoreduction were significant predictors of overall survival. The median OS for non-low-grade and well-differentiated tumor patients who received adjuvant chemotherapy following complete cytoreduction was 9.03 years, compared to 2.88 years for patients who did not receive adjuvant chemotherapy (P = .02). Among low-grade and well-differentiated tumor patients who underwent complete cytoreduction, there was no statistically significant difference in OS between those who received adjuvant chemotherapy and those who did not.

Conclusion: Adjuvant chemotherapy seems to have benefit in appendiceal cancer patients with non-low-grade or well-differentiated tumor type but not in low-grade or well-differentiated tumors.

Keywords: adjuvant chemotherapy; appendiceal cancer; impact of chemotherapy; overall survival; progression-free survival.

Publication types

Research Support, N.I.H., Extramural

MeSH terms

Adenocarcinoma / drug therapy
Adenocarcinoma / pathology
Adenocarcinoma, Mucinous / drug therapy*
Adenocarcinoma, Mucinous / pathology
Adult
Aged
Antineoplastic Combined Chemotherapy Protocols / therapeutic use*
Appendiceal Neoplasms / drug therapy*
Appendiceal Neoplasms / pathology
Capecitabine / administration & dosage
Carcinoma, Signet Ring Cell / drug therapy*
Carcinoma, Signet Ring Cell / pathology
Chemotherapy, Adjuvant
Cytoreduction Surgical Procedures*
Disease-Free Survival
Female
Fluorouracil / administration & dosage
Humans
Hyperthermic Intraperitoneal Chemotherapy*
Male
Middle Aged
Neoplasm Grading
Oxaliplatin / administration & dosage
Proportional Hazards Models
Retrospective Studies
Survival Rate

Substances

Oxaliplatin
Capecitabine
Fluorouracil

Abstract

Publication types

MeSH terms

Substances

Grants and funding