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. 2022 May;37(5):1173-1180.
doi: 10.1007/s00384-022-04132-8. Epub 2022 Apr 26.

The association between appendicitis severity and patient age with appendiceal neoplasm histology-a population-based study

Jenny Alajääski #  1   2 , Elina Lietzén #  3   4 , Juha M Grönroos  2   5 , Jukka-Pekka Mecklin  6   7 , Ari Leppäniemi  8   9 , Pia Nordström  10   11 , Tero Rautio  12   13 , Tuomo Rantanen  14   15   16 , Juhani Sand  17 , Hannu Paajanen  18 , Helena Ollila  19 , Paulina Salminen  1   2   5
Affiliations

The association between appendicitis severity and patient age with appendiceal neoplasm histology-a population-based study

Jenny Alajääski et al. Int J Colorectal Dis. 2022 May.

Abstract

Purpose: Recent studies have reported alarming appendiceal tumor rates associated with complicated acute appendicitis, especially in patients presenting with a periappendicular abscess. However, the data on histology of appendiceal tumors among acute appendicitis patients is limited, especially in patient cohorts differentiating between uncomplicated and complicated acute appendicitis. We have previously reported the association of increased appendiceal tumor prevalence with complicated acute appendicitis in this population-based study. The objective of this secondary analysis was to evaluate the association of both appendicitis severity and patient age with appendiceal tumor histology.

Methods: This nationwide population-based registry study (The Finnish Cancer Registry) was conducted from 2007 to 2013. All appendiceal tumors (n = 840) and available medical reports (n = 504) of these patients at eight study hospitals were previously evaluated, identifying altogether 250 patients with both acute appendicitis and appendiceal tumor.

Results: The severity of acute appendicitis was significantly associated with more malignant tumor histology. The risk of adenocarcinoma or pseudomyxoma was significantly higher among patients with periappendicular abscess (OR 15.05, CI 95% 6.98-32.49, p < 0.001) and patients presenting with perforated acute appendicitis (OR 4.09, CI 95% 1.69-9.90, p = 0.0018) compared to patients with uncomplicated acute appendicitis. Similarly, patient age over 40 years was significantly associated with the risk of adenocarcinoma and pseudomyxoma (OR 26.46, Cl 95% 7.95-88.09, p < 0.001). Patient sex was not associated with a more malignant appendiceal tumor histology (p = 0.67).

Conclusion: More malignant appendiceal tumor histology of adenocarcinoma or pseudomyxoma was significantly associated with patient age over 40 years and complicated acute appendicitis, especially periappendicular abscess.

Keywords: Appendiceal adenocarcinoma; Appendicitis severity; Goblet cell carcinoma; Mixed adeno-neuroendocrine carcinoma; Neuroendocrine tumor; Pseudomyxoma peritonei.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Patient inclusion from The Finnish Cancer Registry (FCR) between years 2007 and 2013
See this image and copyright information in PMC

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