Who Undergoes Cytoreductive Surgery and Perioperative Intraperitoneal Chemotherapy for Appendiceal Cancer? An Analysis of the National Cancer Database

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Abstract

Background: We sought to identify patterns of care for patients with appendiceal cancer and identify clinical factors associated with patient selection for multimodality treatment, including cytoreductive surgery and perioperative intraperitoneal chemotherapy (CRS/PIC). Materials and methods: National Cancer Database (NCDB) data from 2004 to 2014 of all diagnoses of appendiceal cancers were examined. We examined treatment modalities, as well as demographic, tumor-specific, and survival data. A multivariate logistic regression analysis was performed to determine the patient cohort most likely to receive CRS/PIC. Kaplan–Meier was used to estimate survival for all treatment groups. Significance was evaluated at P ≤ 0.05. Results: We analyzed data on 18,055 patients. Nine thousand nine hundred ninety-two (55.3%) were treated with surgery only, 5848 (32.4%) received surgery and systemic chemotherapy, 1393 (7.71%) received CRS/PIC, 520 (2.88%) received chemotherapy alone, and 302 (1.67%) received neither surgery nor chemotherapy. Significant predictors of receiving CRS/PIC included male sex (OR 1.33, 95% CI: 1.11-1.59), white race (OR 2.00, 95% CI 1.40-2.86), non-Hispanic ethnicity (OR 1.92, 95% CI 1.21-3.05), private insurance (OR 1.52, 95% CI 1.26-1.84), and well-differentiated tumors (OR 4.25, CI: 3.39-5.32) (P < 0.05). Treatment with CRS/PIC was associated with a higher 5-year survival for mucinous malignancies, when compared to surgery alone (65.6% versus 62.4%, P < 0.01). Treatment with CRS/PIC was also associated with higher 5-year survival for well-differentiated malignancies, when compared to all other treatment modalities (74.9% versus 65.4%, P < 0.01). Conclusions: Patients were more likely to undergo CRS/PIC if they were male, white, privately insured, and with well-differentiated tumors. CRS/PIC was associated with improved survival in patients with mucinous and low-grade tumors.

Original languageEnglish (US)
Pages (from-to)198-206
Number of pages9
JournalJournal of Surgical Research
Volume238
DOIs
StatePublished - Jun 1 2019

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Appendiceal Neoplasms
Databases
Drug Therapy
Neoplasms
Survival
Patient Selection
Therapeutics
Insurance

Keywords

  • Appendiceal cancer
  • Cytoreductive surgery (CRS)
  • Hyperthermic intraperitoneal chemotherapy (HIPEC)
  • National cancer database (NCDB)
  • Perioperative intraperitoneal chemotherapy (PIC)

ASJC Scopus subject areas

  • Surgery

Cite this

@article{ab0c965d3a4443ee8145c83720a317d9,
title = "Who Undergoes Cytoreductive Surgery and Perioperative Intraperitoneal Chemotherapy for Appendiceal Cancer? An Analysis of the National Cancer Database",
abstract = "Background: We sought to identify patterns of care for patients with appendiceal cancer and identify clinical factors associated with patient selection for multimodality treatment, including cytoreductive surgery and perioperative intraperitoneal chemotherapy (CRS/PIC). Materials and methods: National Cancer Database (NCDB) data from 2004 to 2014 of all diagnoses of appendiceal cancers were examined. We examined treatment modalities, as well as demographic, tumor-specific, and survival data. A multivariate logistic regression analysis was performed to determine the patient cohort most likely to receive CRS/PIC. Kaplan–Meier was used to estimate survival for all treatment groups. Significance was evaluated at P ≤ 0.05. Results: We analyzed data on 18,055 patients. Nine thousand nine hundred ninety-two (55.3{\%}) were treated with surgery only, 5848 (32.4{\%}) received surgery and systemic chemotherapy, 1393 (7.71{\%}) received CRS/PIC, 520 (2.88{\%}) received chemotherapy alone, and 302 (1.67{\%}) received neither surgery nor chemotherapy. Significant predictors of receiving CRS/PIC included male sex (OR 1.33, 95{\%} CI: 1.11-1.59), white race (OR 2.00, 95{\%} CI 1.40-2.86), non-Hispanic ethnicity (OR 1.92, 95{\%} CI 1.21-3.05), private insurance (OR 1.52, 95{\%} CI 1.26-1.84), and well-differentiated tumors (OR 4.25, CI: 3.39-5.32) (P < 0.05). Treatment with CRS/PIC was associated with a higher 5-year survival for mucinous malignancies, when compared to surgery alone (65.6{\%} versus 62.4{\%}, P < 0.01). Treatment with CRS/PIC was also associated with higher 5-year survival for well-differentiated malignancies, when compared to all other treatment modalities (74.9{\%} versus 65.4{\%}, P < 0.01). Conclusions: Patients were more likely to undergo CRS/PIC if they were male, white, privately insured, and with well-differentiated tumors. CRS/PIC was associated with improved survival in patients with mucinous and low-grade tumors.",
keywords = "Appendiceal cancer, Cytoreductive surgery (CRS), Hyperthermic intraperitoneal chemotherapy (HIPEC), National cancer database (NCDB), Perioperative intraperitoneal chemotherapy (PIC)",
author = "Byrne, {Raphael M.} and Erin Gilbert and Dewey, {Elizabeth N.} and Daniel Herzig and Kim Lu and Kevin Billingsley and Karen Deveney and Vassiliki Tsikitis",
year = "2019",
month = "6",
day = "1",
doi = "10.1016/j.jss.2019.01.039",
language = "English (US)",
volume = "238",
pages = "198--206",
journal = "Journal of Surgical Research",
issn = "0022-4804",
publisher = "Academic Press Inc.",

}

TY - JOUR

T1 - Who Undergoes Cytoreductive Surgery and Perioperative Intraperitoneal Chemotherapy for Appendiceal Cancer? An Analysis of the National Cancer Database

AU - Byrne, Raphael M.

AU - Gilbert, Erin

AU - Dewey, Elizabeth N.

AU - Herzig, Daniel

AU - Lu, Kim

AU - Billingsley, Kevin

AU - Deveney, Karen

AU - Tsikitis, Vassiliki

PY - 2019/6/1

Y1 - 2019/6/1

N2 - Background: We sought to identify patterns of care for patients with appendiceal cancer and identify clinical factors associated with patient selection for multimodality treatment, including cytoreductive surgery and perioperative intraperitoneal chemotherapy (CRS/PIC). Materials and methods: National Cancer Database (NCDB) data from 2004 to 2014 of all diagnoses of appendiceal cancers were examined. We examined treatment modalities, as well as demographic, tumor-specific, and survival data. A multivariate logistic regression analysis was performed to determine the patient cohort most likely to receive CRS/PIC. Kaplan–Meier was used to estimate survival for all treatment groups. Significance was evaluated at P ≤ 0.05. Results: We analyzed data on 18,055 patients. Nine thousand nine hundred ninety-two (55.3%) were treated with surgery only, 5848 (32.4%) received surgery and systemic chemotherapy, 1393 (7.71%) received CRS/PIC, 520 (2.88%) received chemotherapy alone, and 302 (1.67%) received neither surgery nor chemotherapy. Significant predictors of receiving CRS/PIC included male sex (OR 1.33, 95% CI: 1.11-1.59), white race (OR 2.00, 95% CI 1.40-2.86), non-Hispanic ethnicity (OR 1.92, 95% CI 1.21-3.05), private insurance (OR 1.52, 95% CI 1.26-1.84), and well-differentiated tumors (OR 4.25, CI: 3.39-5.32) (P < 0.05). Treatment with CRS/PIC was associated with a higher 5-year survival for mucinous malignancies, when compared to surgery alone (65.6% versus 62.4%, P < 0.01). Treatment with CRS/PIC was also associated with higher 5-year survival for well-differentiated malignancies, when compared to all other treatment modalities (74.9% versus 65.4%, P < 0.01). Conclusions: Patients were more likely to undergo CRS/PIC if they were male, white, privately insured, and with well-differentiated tumors. CRS/PIC was associated with improved survival in patients with mucinous and low-grade tumors.

AB - Background: We sought to identify patterns of care for patients with appendiceal cancer and identify clinical factors associated with patient selection for multimodality treatment, including cytoreductive surgery and perioperative intraperitoneal chemotherapy (CRS/PIC). Materials and methods: National Cancer Database (NCDB) data from 2004 to 2014 of all diagnoses of appendiceal cancers were examined. We examined treatment modalities, as well as demographic, tumor-specific, and survival data. A multivariate logistic regression analysis was performed to determine the patient cohort most likely to receive CRS/PIC. Kaplan–Meier was used to estimate survival for all treatment groups. Significance was evaluated at P ≤ 0.05. Results: We analyzed data on 18,055 patients. Nine thousand nine hundred ninety-two (55.3%) were treated with surgery only, 5848 (32.4%) received surgery and systemic chemotherapy, 1393 (7.71%) received CRS/PIC, 520 (2.88%) received chemotherapy alone, and 302 (1.67%) received neither surgery nor chemotherapy. Significant predictors of receiving CRS/PIC included male sex (OR 1.33, 95% CI: 1.11-1.59), white race (OR 2.00, 95% CI 1.40-2.86), non-Hispanic ethnicity (OR 1.92, 95% CI 1.21-3.05), private insurance (OR 1.52, 95% CI 1.26-1.84), and well-differentiated tumors (OR 4.25, CI: 3.39-5.32) (P < 0.05). Treatment with CRS/PIC was associated with a higher 5-year survival for mucinous malignancies, when compared to surgery alone (65.6% versus 62.4%, P < 0.01). Treatment with CRS/PIC was also associated with higher 5-year survival for well-differentiated malignancies, when compared to all other treatment modalities (74.9% versus 65.4%, P < 0.01). Conclusions: Patients were more likely to undergo CRS/PIC if they were male, white, privately insured, and with well-differentiated tumors. CRS/PIC was associated with improved survival in patients with mucinous and low-grade tumors.

KW - Appendiceal cancer

KW - Cytoreductive surgery (CRS)

KW - Hyperthermic intraperitoneal chemotherapy (HIPEC)

KW - National cancer database (NCDB)

KW - Perioperative intraperitoneal chemotherapy (PIC)

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U2 - 10.1016/j.jss.2019.01.039

DO - 10.1016/j.jss.2019.01.039

M3 - Article

VL - 238

SP - 198

EP - 206

JO - Journal of Surgical Research

JF - Journal of Surgical Research

SN - 0022-4804

ER -