According to a retrospective institutional review published covering cases treated between January 2021 and December 2025, tumour biology primarily determines the overall survival and prognosis of appendiceal neoplasms, with low-grade appendiceal mucinous neoplasms (LAMN) demonstrating significantly better survival rates than high-risk histological variants.
Clinicopathological Characteristics of Treated Appendiceal Neoplasms
Data retrieved from medical records at a tertiary-level cancer centre in India show a median patient age of 54 years, with a 95% confidence interval ranging from 46 to 61 years. Female patients accounted for a slight majority of the 55-patient cohort at 54.5%, or 30 individuals, according to institutional databases. Histological subtypes varied across the group: LAMN represented 67.3% of cases (37 patients), high-grade appendiceal mucinous neoplasms (HAMN) made up 14.5% (8 patients), standard adenocarcinomas comprised 14.5% (8 patients), and signet ring adenocarcinomas accounted for 3.6% (2 patients). More than 70% of patients were initially referred from outside hospitals following appendectomies performed for acute appendicitis, highlighting how frequently these rare tumours present as mimicry of acute inflammatory conditions.
Disease Staging and Metastatic Presentation
Among 41 patients with assignable tumour stages based on the eighth edition of the American Joint Committee on Cancer (AJCC) staging system, advanced disease predominated. Stage IV disease accounted for 53.7% of staged cases, representing 22 out of 41 patients.
Overall Survival and Histological Impact
Overall survival differed significantly by histopathology, according to log-rank testing (p = 0.026). In Cox proportional hazards analysis, LAMN histology associated with a lower risk of death, yielding a hazard ratio (HR) of 0.24 and a p-value of 0.040. Patients with LAMN exhibited high survival rates (> 85%) up to three years, with very few deaths observed, whereas patients with other histological subtypes experienced lower survival curves. For patients with LAMN specifically, survival did not differ significantly between those undergoing appendectomy alone versus major surgical procedures such as right hemicolectomy, cytoreductive surgery (CRS), or CRS combined with HIPEC (log-rank p = 0.48). Both groups demonstrated high survival rates exceeding 85% up to three years, with minimal observed deaths.
Surgical Management and Therapeutic Options
Treatment was individualized based on disease extent and histopathological findings. Of the cohort, 33 patients underwent subsequent surgery after initial presentation, consisting of appendectomy (7 patients), right hemicolectomy (20 patients), CRS (4 patients), and CRS plus HIPEC (2 patients). Mitomycin C was utilized for HIPEC protocols in mucinous neoplasms, while adenocarcinoma patients received cisplatin combined with mitomycin C alongside adjuvant systemic CAPOX chemotherapy for six months. Retrospective findings indicate that low-grade lesions often allow favourable survival outcomes without recurrence, whereas high-risk variants require aggressive multidisciplinary intervention.
Did You Know?
Frequently Asked Questions
What is the most common histological subtype of appendiceal neoplasms?
Low-grade appendiceal mucinous neoplasm (LAMN) is the most common subtype, representing 67.3% of cases in institutional cohorts.
How does tumour biology affect overall survival in appendiceal tumours?
Tumour biology is the key prognostic determinant; patients with LAMN experience significantly better survival rates and a lower hazard of death compared to high-grade variants like adenocarcinomas and signet ring cell carcinomas.
Is right hemicolectomy always required for LAMN?
According to survival analyses among LAMN patients, overall survival showed no statistically significant difference between those undergoing appendectomy alone versus more extensive surgical procedures, with both groups maintaining survival rates above 85% at three years.
What causes pseudomyxoma peritonei in appendiceal neoplasms?
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