低级别阑尾腺癌发生淋巴结转移的可能性存在差异，右结肠切除术的作用尚不清楚。我们的目的是确定淋巴血管侵犯的患病率和效用，以预测淋巴结转移的风险，以帮助对可能受益于右半结肠切除术的患者进行分层。从国家癌症数据库（2010-2017）中确定了患有非转移性低级别阑尾腺癌的患者。主要结果是淋巴结转移的可能性。使用逻辑回归来识别淋巴结转移的独立预测因子。 4 级风险模型（COH 综合评分）是通过为高风险特征（淋巴血管侵犯、T3/T4 T 分期或非粘液性组织学）各分配 1 分来计算的。使用Kaplan-Meier方法进行生存分析。使用多变量 Cox 回归分析来确定生存的独立预测因子。共鉴定出 1,303 名非转移性低级别阑尾腺癌（64.2% 为粘液性）患者。在 1,133 名已知淋巴管侵犯状态的患者中，78 名（6.9%）呈淋巴管侵犯阳性。在多变量分析中，淋巴血管侵犯与淋巴结转移独立相关（比值比，8.68；P < .001）。淋巴血管侵犯预测淋巴结转移的总体准确率为 86%。 COH 综合评分将患者分为 4 类，淋巴结转移风险增加且生存率逐渐恶化。对于COH综合评分为0（12%）的患者，淋巴结转移率为3.1%，并且该组中的右半结肠切除术并没有提高生存率。淋巴血管侵犯的存在强烈预测淋巴结转移。淋巴血管侵犯作为 COH 综合评分的一部分可能有助于指导低级别阑尾腺癌的手术范围。版权所有 © 2024 Elsevier Inc. 保留所有权利。

There is variation in the probability of nodal metastases from low-grade appendiceal adenocarcinomas, and the role of right colectomy is unclear. We aimed to define the prevalence and utility of lymphovascular invasion in predicting the risk of nodal metastases to help stratify patients who may benefit from right hemicolectomy.Patients with nonmetastatic low-grade appendiceal adenocarcinomas were identified from the National Cancer Database (2010-2017). The primary outcome was probability of nodal metastases. Logistic regression was used to identify independent predictors of nodal metastases. A 4-tier risk model-the COH Composite Score-was calculated by assigning 1 point each for a high-risk feature (lymphovascular invasion, T3/T4 T stage, or nonmucinous histology). Survival analysis was performed using the Kaplan-Meier method. Multivariate Cox regression analysis was used to identify independent predictors of survival.A total of 1,303 patients with nonmetastatic low-grade appendiceal adenocarcinomas (64.2% mucinous) were identified. Of the 1,133 patients with known lymphovascular invasion status, 78 (6.9%) were lymphovascular invasion positive. In multivariate analysis, lymphovascular invasion was independently associated with nodal metastases (odds ratio, 8.68; P < .001). Overall accuracy of lymphovascular invasion in predicting nodal metastases was 86%. The COH Composite Score stratified patients in 4 categories with increasing risk of nodal metastases and incrementally worse survival. For patients with the COH Composite Score of 0 (12%), the nodal metastasis rate was 3.1%, and a right hemicolectomy in this group did not improve survival.The presence of lymphovascular invasion is strongly predictive of nodal metastases. Lymphovascular invasion as part of the COH Composite Score may help guide the extent of surgery in low-grade appendiceal adenocarcinomas.Copyright © 2024 Elsevier Inc. All rights reserved.