Advertisement

Annals of Surgical Oncology

, Volume 23, Issue 13, pp 4338–4343 | Cite as

Curative Surgical Resection as a Component of Multimodality Therapy for Peritoneal Metastases from Goblet Cell Carcinoids

  • Michal Radomski
  • Reetesh K. Pai
  • Yongli Shuai
  • Lekshmi Ramalingam
  • Heather Jones
  • Matthew P. Holtzman
  • Steven A. Ahrendt
  • James F. Pingpank
  • Herbert J. Zeh
  • David L. Bartlett
  • Haroon A. Choudry
Gastrointestinal Oncology

Abstract

Background

The impact of histopathologic features on oncologic outcomes for patients with peritoneal metastases from goblet cell carcinoid (GCC) undergoing multimodality therapy, including cytoreductive surgery with hyperthermic intraperitoneal chemoperfusion (CRS-HIPEC), is unknown.

Methods

This study prospectively analyzed 43 patients with GCC undergoing CRS-HIPEC between 2005 and 2013. Pathology slides were re-reviewed to classify GCC into histologic subtypes according to the Tang classification. Kaplan–Meier survival curves and multivariate Cox-regression models identified prognostic factors affecting oncologic outcomes.

Results

The 43 patients in this study underwent 50 CRS-HIPEC procedures for peritoneal metastases from GCC, and the majority received neoadjuvant and/or adjuvant systemic chemotherapy. The GCC demonstrated an aggressive phenotype with frequent lymph node and peritoneal metastases without systemic dissemination. The majority of the patients had Tang B GCC. The estimated median overall survival times after surgery for the patients with Tang A, B, and C GCC were respectively 59, 22, and 13 months. In a multivariate Cox-regression analysis, poor survival was associated with patients who had Tang B or C GCC, those undergoing incomplete macroscopic resection, and those with symptoms at the time of CRS-HIPEC. The patients with Tang A GCC demonstrated oncologic outcomes similar to those with intermediate-grade (American Joint Committee on Cancer [AJCC] grade 2) disseminated mucinous appendiceal neoplasms, whereas the patients with Tang B and C GCC demonstrated survival rates similar to or worse than those with high-grade (AJCC grade 3) disseminated mucinous appendiceal neoplasms.

Conclusions

Tang classification is an independent prognostic factor for poor survival after multimodality therapy for GCC. Patients with Tang C GCC demonstrate limited survival and are not ideal candidates for a surgical approach.

Keywords

Oncologic Outcome Peritoneal Metastasis Intraperitoneal Chemotherapy Peritoneal Cancer Index Early Postoperative Intraperitoneal Chemotherapy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgment

This work was partially funded by generous support from Valarie Koch and the New Era Cap Company.

Disclosure

None

References

  1. 1.
    McCusker ME, Cote TR, Clegg LX, Sobin LH. Primary malignant neoplasms of the appendix: a population-based study from the surveillance, epidemiology, and end-results program, 1973–1998. Cancer. 2002;94:3307–12.CrossRefPubMedGoogle Scholar
  2. 2.
    Turaga KK, Pappas SG, Gamblin T. Importance of histologic subtype in the staging of appendiceal tumors. Ann Surg Oncol. 2012;19:1379–85.CrossRefPubMedGoogle Scholar
  3. 3.
    Holt N, Gronbaek H. Goblet cell carcinoids of the appendix. Sci World J. 2013;2013:543696.CrossRefGoogle Scholar
  4. 4.
    Tang LH, Shia J, Soslow RA, et al. Pathologic classification and clinical behavior of the spectrum of goblet cell carcinoid tumors of the appendix. Am J Surg Pathol. 2008;32:1429–43.CrossRefPubMedGoogle Scholar
  5. 5.
    Roy P, Chetty R. Goblet cell carcinoid tumors of the appendix: an overview. World J Gastrointest Oncol. 2010;2:251–8.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Liu E, Telem DA, Warner RR, Dikman A, Divino CM. The role of Ki-67 in predicting biological behavior of goblet cell carcinoid tumor in appendix. Am J Surg. 2011;202:400–3.CrossRefPubMedGoogle Scholar
  7. 7.
    Pahlavan PS, Kanthan R. Goblet cell carcinoid of the appendix. World J Surg Oncol. 2005;3:36.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Cashin P, Nygren P, Hellman P, Granberg D, Andreasson H, Mahteme H. Appendiceal adenocarcinoids with peritoneal carcinomatosis treated with cytoreductive surgery and intraperitoneal chemotherapy: a retrospective study of in vitro drug sensitivity and survival. Clin Colorectal Cancer. 2011;10:108–12.CrossRefPubMedGoogle Scholar
  9. 9.
    Mahteme H, Sugarbaker PH. Treatment of peritoneal carcinomatosis from adenocarcinoid of appendiceal origin. Br J Surg. 2004;91:1168–73.CrossRefPubMedGoogle Scholar
  10. 10.
    McConnell YJ, Mack LA, Gui X, et al. Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy: an emerging treatment option for advanced goblet cell tumors of the appendix. Ann Surg Oncol. 2014;21:1975–82.CrossRefPubMedGoogle Scholar
  11. 11.
    Butler JA, Houshiar A, Lin F, Wilson SE. Goblet cell carcinoid of the appendix. Am J Surg. 1994;168:685–7.CrossRefPubMedGoogle Scholar
  12. 12.
    Garin L, Corbinais S, Boucher E, Blanchot J, Le Guilcher P, Raoul JL. Adenocarcinoid of the appendix vermiformis: complete and persistent remission after chemotherapy (folfox) of a metastatic case. Dig Dis Sci. 2002;47:2760–2.CrossRefPubMedGoogle Scholar
  13. 13.
    Mandai M, Konishi I, Tsuruta Y, et al. Krukenberg tumor from an occult appendiceal adenocarcinoid: a case report and review of the literature. Eur J Obstet Gynecol Reprod Biol. 2001;97:90–5.CrossRefPubMedGoogle Scholar
  14. 14.
    Stancu M, Wu TT, Wallace C, Houlihan PS, Hamilton SR, Rashid A. Genetic alterations in goblet cell carcinoids of the vermiform appendix and comparison with gastrointestinal carcinoid tumors. Mod Pathol. 2003;16:1189–98.CrossRefPubMedGoogle Scholar
  15. 15.
    Jacquet P, Sugarbaker PH. Clinical research methodologies in diagnosis and staging of patients with peritoneal carcinomatosis. Cancer Treat Res. 1996;82:359–74.CrossRefPubMedGoogle Scholar
  16. 16.
    Bao P, Bartlett D. Surgical techniques in visceral resection and peritonectomy procedures. Cancer J. 2009;15:204–11.CrossRefPubMedGoogle Scholar
  17. 17.
    Clavien PA, Barkun J, de Oliveira ML, et al. The Clavien–Dindo classification of surgical complications: five-year experience. Ann Surg. 2009;250:187–96.CrossRefPubMedGoogle Scholar
  18. 18.
    Davison JM, Choudry HA, Pingpank JF, et al. Clinicopathologic and molecular analysis of disseminated appendiceal mucinous neoplasms: identification of factors predicting survival and proposed criteria for a three-tiered assessment of tumor grade. Mod Pathol. 2014;27:1521–39.CrossRefPubMedGoogle Scholar

Copyright information

© Society of Surgical Oncology 2016

Authors and Affiliations

  • Michal Radomski
    • 1
  • Reetesh K. Pai
    • 2
  • Yongli Shuai
    • 3
  • Lekshmi Ramalingam
    • 1
  • Heather Jones
    • 1
  • Matthew P. Holtzman
    • 1
  • Steven A. Ahrendt
    • 1
  • James F. Pingpank
    • 1
  • Herbert J. Zeh
    • 1
  • David L. Bartlett
    • 1
  • Haroon A. Choudry
    • 1
  1. 1.Division of Surgical OncologyUniversity of PittsburghPittsburghUSA
  2. 2.Department of PathologyUniversity of PittsburghPittsburghUSA
  3. 3.The University of Pittsburgh Cancer Institute Biostatistics FacilityPittsburghUSA

Personalised recommendations