Abstract
Background
There is limited knowledge about the epidemiology of the major histological subtypes of appendiceal malignancy: adenocarcinoma and neuroendocrine neoplasm of the appendix (A-NEN). The aims of this national cohort study were to assess the prevalence, incidence and trends of appendiceal malignancies in Sweden.
Method
All individuals who underwent appendicectomy and all diagnosed with appendiceal malignancy from 1970 to 2012 were identified from the National Patient Register and the Swedish Cancer Registry. Demographic data of the background population were obtained from Statistics Sweden. The incidence rate (IR) and the prevalence of appendiceal malignancy per performed appendicectomy were calculated.
Results
We identified 3774 patients with appendiceal malignancy. IR of A-NEN was 5.8/106 person-years with a peak of 8.4/106 at age 20–30 years, whereafter it plateaued at a somewhat lower level. IR for adenocarcinoma was 3.7/106 person-years, starting at a very low level among the youngest and increasing to 15.4/106 at age 80–89 years. The IR of adenocarcinoma increased from 2.6/106 in 1970–1979 to 5.4/106 in 2010–2012. The IR of A-NEN was stable during the study period. The prevalence per appendicectomy was low for both types of malignancies among the young but increased with age, most dramatically for adenocarcinoma. There was a trend during the study period towards more extensive surgery.
Conclusion
Adenocarcinoma is most common and increasing in the elderly, whereas A-NEN affects all ages with a peak in young age. This peak probably reflects removal of occult A-NEN due to the higher appendicectomy frequency in the young.
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References
Tang LH (2010) Epithelial neoplasms of the appendix. Arch Pathol Lab Med 134:1612–1620
Misdraji J (2010) Appendiceal mucinous neoplasms: controversial issues. Arch Pathol Lab Med 134:864–870
McCusker ME, Coté TR, Clegg LX et al (2002) Primary malignant neoplasms of the appendix: a population-based study from the surveillance, epidemiology and end-results program, 1973–1998. Cancer 94:3307–3312
Turaga KK, Pappas SG, Gamblin T (2012) Importance of histologic subtype in the staging of appendiceal tumors. Ann Surg Oncol 19:1379–1385
Marmor S, Portschy PR, Tuttle TM et al (2015) The rise in appendiceal cancer incidence: 2000–2009. J Gastrointest Surg 19:743–750
Mullen JT, Savarese DM (2011) Carcinoid tumors of the appendix: a population-based study. J Surg Oncol 104:41–44
Nielsen GP, Isaksson HJ, Finnbogason H et al (1991) Adenocarcinoma of the vermiform appendix. A population study. APMIS 99:653–656
Smeenk RM, van Velthuysen ML, Verwaal VJ et al (2008) Appendiceal neoplasms and pseudomyxoma peritonei: a population based study. Eur J Surg Oncol 34:196–201
Dasari A, Shen C, Halperin D et al (2017) Trends in the incidence, prevalence, and survival outcomes in patients with neuroendocrine tumors in the United States. JAMA Oncol 3:1335–1342
Ellis L, Shale MJ, Coleman MP (2010) Carcinoid tumors of the gastrointestinal tract: trends in incidence in England since 1971. Am J Gastroenterol 105:2563–3569
Swank HA, Eshuis EJ, Ubbink DT et al (2011) Is routine histopathological examination of appendectomy specimens useful? A systematic review of the literature. Colorectal Dis 13:1214–1221
Statistics CBo (2017) Statistikdatabasen. https://www.statistikdatabasen.scb.se/pxweb/sv/ssd/START__BE__BE0101__BE0101A/BefolkningR1860/?rxid=6fe9e41d-f130-44da-928b-43eb297669b3. Accessed 21 Aug 2018
Surveillance E, End Results program. Standard populations—19 age groups. https://seer.cancer.gov/stdpopulations/stdpop.19ages.html. Accessed 21 Aug 2018
van den Heuvel MG, Lemmens VE, Verhoeven RH et al (2013) The incidence of mucinous appendiceal malignancies: a population-based study. Int J Colorectal Dis 28:1307–1310
Nyström G (1932) Wachsende appendicitismortalität. Acta Chir Scand 72:236–260
Andersson R, Hugander A, Thulin A et al (1994) Indications for operation in suspected appendicitis and incidence of perforation. BMJ 308:107–110
The Swedish National Board of Health and Welfare. National Patient Register. Cited 07 July 2020
Pape UF et al (2016) ENETS consensus guidelines for neuroendocrine neoplasms of the appendix (Excluding goblet cell carcinomas). Neuroendocrinology 2016(103):144–152
Hatch QM, Gilbert EW (2018) Appendiceal neoplasms. Clin Colon Rectal Surg 31:278–287
Fleischmann I et al (2017) Improved survival after retrieval of 12 or more regional lymph nodes in appendiceal cancer. Eur J Surg Oncol 43:1876–1885
Funding
This study was supported by Futurum, Academy for Health and Care, Region Jönköping County, Sweden.
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The study was approved by the Regional Ethical Review Board at Linköping University.
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Johansson, J., Andersson, R.E., Landerholm, K. et al. Incidence of Appendiceal Malignancies in Sweden Between 1970 and 2012. World J Surg 44, 4086–4092 (2020). https://doi.org/10.1007/s00268-020-05758-x
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DOI: https://doi.org/10.1007/s00268-020-05758-x