Τίτλος:
The effect of prophylactic surgery in survival and HRQoL in appendiceal NEN
Γλώσσες Τεκμηρίου:
Αγγλικά
Περίληψη:
Background/aims: Long-term outcomes are understudied in patients with well-differentiated appendiceal neuroendocrine neoplasms (WD-ANENs). We aimed to evaluate the validity of currently applied criteria for completion prophylactic right hemicolectomy (pRHC) and determine its association with patient outcomes, including health-related quality of life (HRQoL). Methods: Eligible patients from five European referral centers were divided between those who underwent appendectomy alone and those who underwent completion pRHC. HRQoL EORTC-QLC-C30 questionnaires and cross-sectional imaging data were prospectively collected. Age- and sex-matched healthy controls were recruited for HRQoL analysis’ validation. Results: We included 166 patients (119 women [71.2%]: mean age at baseline: 31 ± 16 years). Mean follow-up was 50.9 ± 54 months. Most patients (152 [92%]) had tumors ≤20 mm in size. Fifty-eight patients (34.9%) underwent pRHC that in final analysis was regarded as an overtreatment in 38/58 (65.5%). In multivariable analysis, tumor size >20 mm was the only independent predictor for lymph node (LN) involvement (p = 0.002). No mortality was reported, whereas 2-, 5- and 10-year recurrence-free survival in patients subjected to postoperative cross-sectional imaging (n = 136) was 98.5%, 97.8%, and 97.8%, respectively. Global HRQoL was not significantly impaired in patients with WD-ANEN compared with age- and sex-matched healthy individuals (median scores 0.83[0.08−1] vs 0.83[0.4−1], respectively; p = 0.929). Among patients with WD-ANEN impaired social functioning (p = 0.016), diarrhea (p = 0.003) and financial difficulties (0.024) were more frequently reported in the pRHC group. Conclusions: WD-ANEN is a low-malignant neoplasm with unconfirmed associated mortality, low recurrence rate, and overall preserved HRQoL. pRHC comes at a price of excessive surgery, functional HRQoL issues, and diarrhea. The value per se of a prophylactic surgical approach to patients with WD-ANENs <20 mm is challenged. © 2020, The Author(s).
Συγγραφείς:
Alexandraki, K.I.
Kaltsas, G.
Grozinsky-Glasberg, S.
Oleinikov, K.
Kos-Kudła, B.
Kogut, A.
Srirajaskanthan, R.
Pizanias, M.
Poulia, K.-A.
Ferreira, C.
Weickert, M.O.
Daskalakis, K.
Περιοδικό:
Endocrine Development
Λέξεις-κλειδιά:
adult; appendectomy; appendix tumor; Article; controlled study; diarrhea; European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30; female; financial deficit; follow up; hemicolectomy; human; lymph node; major clinical study; male; neuroendocrine tumor; postoperative period; predictor variable; priority journal; prognosis; prophylactic surgical procedure; quality of life; recurrence free survival; recurrence risk; social interaction; survival; treatment outcome; tumor volume; well differentiated appendiceal neuroendocrine neoplasm; questionnaire; tumor recurrence, Appendiceal Neoplasms; Female; Humans; Neoplasm Recurrence, Local; Neuroendocrine Tumors; Quality of Life; Surveys and Questionnaires
DOI:
10.1007/s12020-020-02356-8
