{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T07:10:06Z","timestamp":1792825806417,"version":"4.5.0"},"reference-count":55,"publisher":"American Medical Association (AMA)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"Importance<\/jats:title>Appendiceal adenocarcinoma is a rare tumor, and given the inherent difficulties in performing prospective trials in such a rare disease, there are currently minimal high-quality data to guide treatment decisions, highlighting the need for more preclinical and clinical investigation for this disease.<\/jats:p><\/jats:sec>Objective<\/jats:title>To prospectively evaluate the effectiveness of fluoropyrimidine-based systemic chemotherapy in patients with inoperable low-grade mucinous appendiceal adenocarcinoma.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>This open-label randomized crossover trial recruited patients at a single tertiary care comprehensive cancer center from September 2013 to January 2021. The data collection cutoff was May 2022. Enrollment of up to 30 patients was planned. Eligible patients had histological evidence of a metastatic low-grade mucinous appendiceal adenocarcinoma, with radiographic imaging demonstrating the presence of mucinous peritoneal carcinomatosis and were not considered candidates for complete cytoreductive surgery. Key exclusion criteria were concurrent or recent investigational therapy, evidence of bowel obstruction, and use of total parenteral nutrition. Data were analyzed from November 2021 to May 2022.<\/jats:p><\/jats:sec>Interventions<\/jats:title>Patients were randomized to either 6 months observation followed by 6 months of chemotherapy, or initial chemotherapy followed by observation.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>The primary end point was the percentage difference in tumor growth in treatment and observation groups. Key secondary end points included patient-reported outcomes in the chemotherapy and observation periods, objective response rate, rate of bowel complications, and differences in overall survival (OS).<\/jats:p><\/jats:sec>Results<\/jats:title>A total of 24 patients were enrolled, with median (range) age of 63 (38 to 82) years, and equal proportion of men and women (eg, 12 men [50%]); all patients had ECOG performance status of 0 or 1. A total of 11 patients were randomized to receive chemotherapy first, and 13 patients were randomized to receive observation first. Most patients (15 patients [63%]) were treated with either fluorouracil or capecitabine as single agent; 3 patients (13%) received doublet chemotherapy (leucovorin calcium [folinic acid], fluorouracil, and oxaliplatin or folinic acid, fluorouracil, and irinotecan hydrochloride), and bevacizumab was added to cytotoxic chemotherapy for 5 patients (21%). Fifteen patients were available to evaluate the primary end point of difference in tumor growth during treatment and observation periods. Tumor growth while receiving chemotherapy increased 8.4% (95% CI, 1.5% to 15.3%) from baseline but was not significantly different than tumor growth during observation (4.0%; 95% CI, \u22120.1% to 8.0%;P<\/jats:italic>\u2009=\u2009.26). Of 18 patients who received any chemotherapy, none had an objective response (14 patients [77.8%] had stable disease; 4 patients [22.2%] had progressive disease). Median (range) OS was 53.2 (8.1 to 95.5) months, and there was no significant difference in OS between the observation-first group (76.0 [8.6 to 95.5] months) and the treatment-first group (53.2 [8.1 to 64.1] months; hazard ratio, 0.64; 95% CI, 0.16-2.55;P<\/jats:italic>\u2009=\u2009.48). Patient-reported quality-of-life metrics identified that during treatment, patients experienced significantly worse fatigue (mean [SD] score, 18.5 [18.6] vs 28.9 [21.3];P<\/jats:italic>\u2009=\u2009.02), peripheral neuropathy (mean [SD] score, 6.67 [12.28] vs 38.89 [34.88];P<\/jats:italic>\u2009=\u2009.01), and financial difficulty (mean [SD] score, 8.9 [15.2] vs 28.9 [33.0];P<\/jats:italic>\u2009=\u2009.001) compared with during observation.<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>In this prospective randomized crossover trial of systemic chemotherapy in patients with low-grade mucinous appendiceal adenocarcinoma, patients did not derive clinical benefit from fluorouracil-based chemotherapy, given there were no objective responses, no difference in OS when treatment was delayed 6 months, and no difference in the rate of tumor growth while receiving chemotherapy.<\/jats:p><\/jats:sec>Trial Registration<\/jats:title>ClinicalTrials.gov Identifier:NCT01946854<\/jats:ext-link><\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2023.16161","type":"journal-article","created":{"date-parts":[[2023,6,1]],"date-time":"2023-06-01T15:32:56Z","timestamp":1685633576000},"page":"e2316161","source":"Crossref","is-referenced-by-count":44,"title":["Efficacy of Systemic Chemotherapy in Patients With Low-grade Mucinous Appendiceal Adenocarcinoma"],"prefix":"10.1001","volume":"6","author":[{"given":"John Paul","family":"Shen","sequence":"first","affiliation":[{"name":"Department of Gastrointestinal Medical Oncology, University of Texas MD Anderson Cancer Center, Houston"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdelrahman M.","family":"Yousef","sequence":"additional","affiliation":[{"name":"Department of Gastrointestinal Medical Oncology, University of Texas MD Anderson Cancer Center, Houston"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fadl A.","family":"Zeineddine","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Houston Methodist Hospital, Houston, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammad A.","family":"Zeineddine","sequence":"additional","affiliation":[{"name":"Department of Gastrointestinal Medical Oncology, University of Texas MD Anderson Cancer Center, Houston"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca S.","family":"Tidwell","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen A.","family":"Beaty","sequence":"additional","affiliation":[{"name":"Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa C.","family":"Scofield","sequence":"additional","affiliation":[{"name":"Department of Gastrointestinal Medical Oncology, University of Texas MD Anderson Cancer Center, Houston"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Safia","family":"Rafeeq","sequence":"additional","affiliation":[{"name":"Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas","family":"Hornstein","sequence":"additional","affiliation":[{"name":"Department of Gastrointestinal Medical Oncology, University of Texas MD Anderson Cancer Center, Houston"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth","family":"Lano","sequence":"additional","affiliation":[{"name":"Department of Radiology, University of Texas MD Anderson Cancer Center, Houston"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cathy","family":"Eng","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Vanderbilt University, Nashville, Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aurelio","family":"Matamoros","sequence":"additional","affiliation":[{"name":"Department of Radiology, University of Texas MD Anderson Cancer Center, Houston"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wai Chin","family":"Foo","sequence":"additional","affiliation":[{"name":"Department of Pathology, University of Texas MD Anderson Cancer Center, Houston"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abhineet","family":"Uppal","sequence":"additional","affiliation":[{"name":"Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher","family":"Scally","sequence":"additional","affiliation":[{"name":"Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Mansfield","sequence":"additional","affiliation":[{"name":"Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melissa","family":"Taggart","sequence":"additional","affiliation":[{"name":"Department of Pathology, University of Texas MD Anderson Cancer Center, Houston"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kanwal P.","family":"Raghav","sequence":"additional","affiliation":[{"name":"Department of Gastrointestinal Medical Oncology, University of Texas MD Anderson Cancer Center, Houston"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael J.","family":"Overman","sequence":"additional","affiliation":[{"name":"Department of Gastrointestinal Medical Oncology, University of Texas MD Anderson Cancer Center, Houston"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keith","family":"Fournier","sequence":"additional","affiliation":[{"name":"Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2023,6,1]]},"reference":[{"issue":"1","key":"zoi230491r1","doi-asserted-by":"publisher","first-page":"51","DOI":"10.1097\/00000658-199401000-00009","article-title":"The natural history of surgically treated primary adenocarcinoma of the appendix.","volume":"219","author":"Nitecki","year":"1994","journal-title":"Ann Surg"},{"issue":"2","key":"zoi230491r2","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1200\/PO.17.00302","article-title":"Genomic landscape of appendiceal neoplasms.","volume":"2","author":"Ang","year":"2018","journal-title":"JCO Precis Oncol"},{"issue":"9","key":"zoi230491r3","doi-asserted-by":"publisher","first-page":"354","DOI":"10.4251\/wjgo.v9.i9.354","article-title":"Stratification of outcomes for mucinous appendiceal adenocarcinoma with peritoneal metastasis by histological grade.","volume":"9","author":"Grotz","year":"2017","journal-title":"World J Gastrointest Oncol"},{"issue":"4","key":"zoi230491r4","doi-asserted-by":"publisher","first-page":"493","DOI":"10.1016\/j.jamcollsurg.2015.12.012","article-title":"Prognostic molecular subtypes of low-grade cancer of the appendix.","volume":"222","author":"Levine","year":"2016","journal-title":"J Am Coll Surg"},{"issue":"8","key":"zoi230491r5","doi-asserted-by":"publisher","first-page":"845","DOI":"10.1634\/theoncologist.2014-0106","article-title":"FOLFOX-4 chemotherapy for patients with unresectable or relapsed peritoneal pseudomyxoma.","volume":"19","author":"Pietrantonio","year":"2014","journal-title":"Oncologist"},{"issue":"4","key":"zoi230491r6","doi-asserted-by":"publisher","first-page":"774","DOI":"10.1007\/s10147-019-01592-x","article-title":"Efficacy of modified FOLFOX6 chemotherapy for patients with unresectable pseudomyxoma peritonei.","volume":"25","author":"Hiraide","year":"2020","journal-title":"Int J Clin Oncol"},{"issue":"8","key":"zoi230491r8","doi-asserted-by":"publisher","first-page":"1262","DOI":"10.1038\/s41416-020-1015-3","article-title":"Integrated clinico-molecular profiling of appendiceal adenocarcinoma reveals a unique grade-driven entity distinct from colorectal cancer.","volume":"123","author":"Raghav","year":"2020","journal-title":"Br J Cancer"},{"issue":"3","key":"zoi230491r9","doi-asserted-by":"publisher","first-page":"413","DOI":"10.1007\/s00428-020-02906-5","article-title":"Molecular and clinicopathological features of appendiceal mucinous neoplasms.","volume":"478","author":"Yanai","year":"2021","journal-title":"Virchows Arch"},{"issue":"5","key":"zoi230491r11","doi-asserted-by":"publisher","first-page":"43","DOI":"10.1186\/gm559","article-title":"Genome-wide mutational landscape of mucinous carcinomatosis peritonei of appendiceal origin.","volume":"6","author":"Alakus","year":"2014","journal-title":"Genome Med"},{"issue":"12","key":"zoi230491r12","doi-asserted-by":"publisher","first-page":"1270","DOI":"10.1634\/theoncologist.2013-0186","article-title":"Impact of molecular alterations and targeted therapy in appendiceal adenocarcinomas.","volume":"18","author":"Raghav","year":"2013","journal-title":"Oncologist"},{"issue":"6","key":"zoi230491r13","doi-asserted-by":"publisher","first-page":"1072","DOI":"10.1097\/SLA.0b013e318269d680","article-title":"Improving the AJCC\/TNM staging for adenocarcinomas of the appendix: the prognostic impact of histological grade.","volume":"257","author":"Overman","year":"2013","journal-title":"Ann Surg"},{"issue":"2","key":"zoi230491r14","doi-asserted-by":"publisher","first-page":"526","DOI":"10.1245\/s10434-007-9691-2","article-title":"Pseudomyxoma peritonei: clinical pathological and biological prognostic factors in patients treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC).","volume":"15","author":"Baratti","year":"2008","journal-title":"Ann Surg Oncol"},{"issue":"2","key":"zoi230491r15","doi-asserted-by":"publisher","first-page":"213","DOI":"10.1002\/cncr.v122.2","article-title":"The impact of stage, grade, and mucinous histology on the efficacy of systemic chemotherapy in adenocarcinomas of the appendix: analysis of the National Cancer Data Base.","volume":"122","author":"Asare","year":"2016","journal-title":"Cancer"},{"issue":"8","key":"zoi230491r16","doi-asserted-by":"publisher","first-page":"907","DOI":"10.1634\/theoncologist.2014-0294","article-title":"Hyperthermic intraperitoneal chemotherapy following cytoreductive surgery improves outcome in patients with primary appendiceal mucinous adenocarcinoma: a pooled analysis from three tertiary care centers.","volume":"20","author":"Shaib","year":"2015","journal-title":"Oncologist"},{"issue":"7","key":"zoi230491r17","doi-asserted-by":"publisher","first-page":"740","DOI":"10.1002\/jso.23547","article-title":"Perioperative systemic chemotherapy for appendiceal mucinous carcinoma peritonei treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy.","volume":"109","author":"Blackham","year":"2014","journal-title":"J Surg Oncol"},{"issue":"3","key":"zoi230491r18","doi-asserted-by":"publisher","first-page":"446","DOI":"10.1002\/jso.v120.3","article-title":"Systemic chemotherapy and survival in patients with metastatic low-grade appendiceal mucinous adenocarcinoma.","volume":"120","author":"Lu","year":"2019","journal-title":"J Surg Oncol"},{"issue":"6","key":"zoi230491r19","doi-asserted-by":"publisher","first-page":"847","DOI":"10.1111\/his.2017.71.issue-6","article-title":"The histopathological classification, diagnosis and differential diagnosis of mucinous appendiceal neoplasms, appendiceal adenocarcinomas and pseudomyxoma peritonei.","volume":"71","author":"Carr","year":"2017","journal-title":"Histopathology"},{"issue":"10","key":"zoi230491r20","doi-asserted-by":"publisher","first-page":"1332","DOI":"10.1046\/j.1365-2168.1998.00882.x","article-title":"Pseudomyxoma peritonei.","volume":"85","author":"Hinson","year":"1998","journal-title":"Br J Surg"},{"issue":"6","key":"zoi230491r21","doi-asserted-by":"publisher","first-page":"1043","DOI":"10.1007\/s10147-022-02147-3","article-title":"Recurrence of initially localized appendiceal mucinous neoplasms after radical resection: survey analysis and literature review.","volume":"27","author":"Kitai","year":"2022","journal-title":"Int J Clin Oncol"},{"issue":"5","key":"zoi230491r22","doi-asserted-by":"publisher","first-page":"624","DOI":"10.1007\/s10434-006-9708-2","article-title":"Appendiceal neoplasms with peritoneal dissemination: outcomes after cytoreductive surgery and intraperitoneal hyperthermic chemotherapy.","volume":"13","author":"Stewart","year":"2006","journal-title":"Ann Surg Oncol"},{"key":"zoi230491r23","doi-asserted-by":"publisher","DOI":"10.1016\/j.clinsp.2022.100039","article-title":"Efficacy and safety in the use of intraperitoneal hyperthermia chemotherapy and peritoneal cytoreductive surgery for pseudomyxoma peritonei from appendiceal neoplasm: a systematic review.","volume":"77","author":"Floriano","year":"2022","journal-title":"Clinics (Sao Paulo)"},{"key":"zoi230491r24","doi-asserted-by":"publisher","DOI":"10.1016\/j.suronc.2021.101572","article-title":"Indications and outcomes for repeat cytoreductive surgery and heated intra-peritoneal chemotherapy in peritoneal surface malignancy.","volume":"38","author":"Sutton","year":"2021","journal-title":"Surg Oncol"},{"issue":"1","key":"zoi230491r25","doi-asserted-by":"publisher","first-page":"73","DOI":"10.1245\/s10434-019-07956-x","article-title":"Defining and refining the role for surgery and intraperitoneal chemotherapy in the treatment of peritoneal surface malignancies.","volume":"27","author":"Choudry","year":"2020","journal-title":"Ann Surg Oncol"},{"issue":"2","key":"zoi230491r26","doi-asserted-by":"publisher","first-page":"300","DOI":"10.1097\/01.sla.0000152015.76731.1f","article-title":"Long-term survival following treatment of pseudomyxoma peritonei: an analysis of surgical therapy.","volume":"241","author":"Miner","year":"2005","journal-title":"Ann Surg"},{"issue":"1","key":"zoi230491r27","doi-asserted-by":"publisher","first-page":"171","DOI":"10.1007\/s11605-021-05076-0","article-title":"The role of adjuvant chemotherapy following right hemicolectomy for non-metastatic mucinous and nonmucinous appendiceal adenocarcinoma.","volume":"26","author":"AlMasri","year":"2022","journal-title":"J Gastrointest Surg"},{"key":"zoi230491r28","doi-asserted-by":"crossref","DOI":"10.1177\/17588359221112478","article-title":"The role of chemotherapy in the treatment of advanced appendiceal cancers: summary of the literature and future directions.","author":"Strach","year":"2022","journal-title":"Ther Adv Med Oncol"},{"issue":"6","key":"zoi230491r29","first-page":"431","article-title":"Implications of biochemical, cytokinetic, pharmacologic, and toxicologic relationships in the design of optimal therapeutic schedules.","volume":"54","author":"Skipper","year":"1970","journal-title":"Cancer Chemother Rep"},{"issue":"4","key":"zoi230491r30","doi-asserted-by":"crossref","first-page":"409","DOI":"10.1001\/archsurg.1980.01380040037006","article-title":"Pseudomyxoma peritonei.","volume":"115","author":"Fernandez","year":"1980","journal-title":"Arch Surg"},{"issue":"2","key":"zoi230491r31","doi-asserted-by":"crossref","first-page":"396","DOI":"10.1002\/1097-0142(19920715)70:2<396::AID-CNCR2820700205>3.0.CO;2-A","article-title":"Pseudomyxoma peritonei of appendiceal origin: the Memorial Sloan-Kettering Cancer Center experience.","volume":"70","author":"Smith","year":"1992","journal-title":"Cancer"},{"key":"zoi230491r32","first-page":"233","article-title":"Pseudomyxoma peritonei syndrome.","volume":"30","author":"Sugarbaker","year":"1996","journal-title":"Adv Surg"},{"issue":"2","key":"zoi230491r33","doi-asserted-by":"crossref","first-page":"228","DOI":"10.1016\/j.ejca.2008.10.026","article-title":"New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1).","volume":"45","author":"Eisenhauer","year":"2009","journal-title":"Eur J Cancer"},{"issue":"4","key":"zoi230491r34","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1203\/00006450-199704001-00480","article-title":"1-800-RANDOMIZE. A Randomization Software Solution for Multicenter Trials.\u2020 460.","volume":"41","author":"Ratliff","year":"1997","journal-title":"Pediatr Res"},{"issue":"3-4","key":"zoi230491r35","article-title":"The State-Trait Anxiety Inventory.","volume":"5","author":"Spielberger","year":"2017","journal-title":"Interam J Psychol"},{"issue":"5","key":"zoi230491r36","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1093\/jnci\/85.5.365","article-title":"The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology.","volume":"85","author":"Aaronson","year":"1993","journal-title":"J Natl Cancer Inst"},{"issue":"11","key":"zoi230491r38","doi-asserted-by":"crossref","first-page":"1521","DOI":"10.1038\/modpathol.2014.37","article-title":"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.","volume":"27","author":"Davison","year":"2014","journal-title":"Mod Pathol"},{"issue":"10","key":"zoi230491r39","doi-asserted-by":"crossref","first-page":"3400","DOI":"10.1002\/cam4.3009","article-title":"Impact of adjuvant chemotherapy on outcomes in appendiceal cancer.","volume":"9","author":"Kolla","year":"2020","journal-title":"Cancer Med"},{"issue":"3","key":"zoi230491r40","doi-asserted-by":"crossref","first-page":"652","DOI":"10.1093\/annonc\/mdr279","article-title":"Systemic chemotherapy and surgical cytoreduction for poorly differentiated and signet ring cell adenocarcinomas of the appendix.","volume":"23","author":"Lieu","year":"2012","journal-title":"Ann Oncol"},{"issue":"4","key":"zoi230491r41","doi-asserted-by":"crossref","first-page":"591","DOI":"10.1038\/sj.bjc.6604522","article-title":"A phase II study evaluating the use of concurrent mitomycin C and capecitabine in patients with advanced unresectable pseudomyxoma peritonei.","volume":"99","author":"Farquharson","year":"2008","journal-title":"Br J Cancer"},{"issue":"1","key":"zoi230491r42","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1097\/PAS.0000000000000535","article-title":"A consensus for classification and pathologic reporting of pseudomyxoma peritonei and associated appendiceal neoplasia: the results of the Peritoneal Surface Oncology Group International (PSOGI) modified Delphi process.","volume":"40","author":"Carr","year":"2016","journal-title":"Am J Surg Pathol"},{"issue":"2","key":"zoi230491r43","doi-asserted-by":"crossref","first-page":"316","DOI":"10.1002\/cncr.24715","article-title":"Modern systemic chemotherapy in surgically unresectable neoplasms of appendiceal origin: a single-institution experience.","volume":"116","author":"Shapiro","year":"2010","journal-title":"Cancer"},{"issue":"5","key":"zoi230491r44","doi-asserted-by":"crossref","first-page":"1379","DOI":"10.1245\/s10434-012-2238-1","article-title":"Importance of histologic subtype in the staging of appendiceal tumors.","volume":"19","author":"Turaga","year":"2012","journal-title":"Ann Surg Oncol"},{"issue":"3","key":"zoi230491r45","doi-asserted-by":"crossref","first-page":"396","DOI":"10.1016\/j.ejso.2014.08.476","article-title":"Recurrence and outcome after complete tumour removal and hyperthermic intraperitoneal chemotherapy in 512 patients with pseudomyxoma peritonei from perforated appendiceal mucinous tumours.","volume":"41","author":"Lord","year":"2015","journal-title":"Eur J Surg Oncol"},{"issue":"20","key":"zoi230491r46","doi-asserted-by":"crossref","first-page":"2449","DOI":"10.1200\/JCO.2011.39.7166","article-title":"Early- and long-term outcome data of patients with pseudomyxoma peritonei from appendiceal origin treated by a strategy of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy.","volume":"30","author":"Chua","year":"2012","journal-title":"J Clin Oncol"},{"issue":"2","key":"zoi230491r47","doi-asserted-by":"crossref","first-page":"278","DOI":"10.1097\/01.sla.0000133183.15705.71","article-title":"Incomplete cytoreduction in 174 patients with peritoneal carcinomatosis from appendiceal malignancy.","volume":"240","author":"Glehen","year":"2004","journal-title":"Ann Surg"},{"issue":"8","key":"zoi230491r48","doi-asserted-by":"crossref","first-page":"2289","DOI":"10.1245\/s10434-007-9462-0","article-title":"Critical analysis of treatment failure after complete cytoreductive surgery and perioperative intraperitoneal chemotherapy for peritoneal dissemination from appendiceal mucinous neoplasms.","volume":"14","author":"Yan","year":"2007","journal-title":"Ann Surg Oncol"},{"issue":"6","key":"zoi230491r49","doi-asserted-by":"crossref","first-page":"3390","DOI":"10.1245\/s10434-021-11233-1","article-title":"Iterative cytoreduction and hyperthermic intraperitoneal chemotherapy for recurrent mucinous adenocarcinoma of the appendix.","volume":"29","author":"Lopez-Ramirez","year":"2022","journal-title":"Ann Surg Oncol"},{"issue":"33","key":"zoi230491r50","doi-asserted-by":"crossref","first-page":"4877","DOI":"10.1200\/JCO.2009.26.5983","article-title":"Pilot study using molecular profiling of patients\u2019 tumors to find potential targets and select treatments for their refractory cancers.","volume":"28","author":"Von Hoff","year":"2010","journal-title":"J Clin Oncol"},{"issue":"35","key":"zoi230491r51","doi-asserted-by":"crossref","first-page":"4159","DOI":"10.1038\/s41388-022-02388-6","article-title":"Oncogene addiction to GNAS in GNASR201 mutant tumors.","volume":"41","author":"More","year":"2022","journal-title":"Oncogene"},{"issue":"4","key":"zoi230491r52","doi-asserted-by":"crossref","first-page":"743","DOI":"10.1007\/s11605-014-2726-7","article-title":"The rise in appendiceal cancer incidence: 2000-2009.","volume":"19","author":"Marmor","year":"2015","journal-title":"J Gastrointest Surg"},{"issue":"11","key":"zoi230491r53","doi-asserted-by":"crossref","first-page":"1915","DOI":"10.1007\/s00384-019-03387-y","article-title":"Epidemiology of and prognostic factors for appendiceal carcinomas: a retrospective, population-based study.","volume":"34","author":"Mo","year":"2019","journal-title":"Int J Colorectal Dis"},{"issue":"34","key":"zoi230491r54","doi-asserted-by":"crossref","first-page":"3945","DOI":"10.2217\/fon-2019-0229","article-title":"Incidence and survival trends for appendiceal mucinous adenocarcinoma: an analysis of 3237 patients in the Surveillance, Epidemiology, and End Results database.","volume":"15","author":"Yan","year":"2019","journal-title":"Future Oncol"},{"issue":"6","key":"zoi230491r55","doi-asserted-by":"crossref","first-page":"1082","DOI":"10.1097\/XCS.0000000000000172","article-title":"Appendiceal cancer in the National Cancer Database: increasing frequency, decreasing age, and shifting histology.","volume":"234","author":"Salazar","year":"2022","journal-title":"J Am Coll Surg"},{"key":"zoi230491r10","volume-title":"The MD Anderson Manual of Medical Oncology","author":"Gulhati","year":"2022","edition":"4th ed"},{"key":"zoi230491r37","doi-asserted-by":"crossref","DOI":"10.1002\/0470854596","volume-title":"Cross-over Trials in Clinical Research","author":"Senn","year":"2002"},{"key":"zoi230491r7","unstructured":"Network? NCC. NCCN Guidelines Colon Cancer Version 1. Accessed September 2, 2022. https:\/\/www.nccn.org\/professionals\/physician_gls\/pdf\/colon.pdf"}],"container-title":["JAMA Network Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/articlepdf\/2805471\/shen_2023_oi_230491_1684773139.96331.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,12,14]],"date-time":"2023-12-14T15:06:14Z","timestamp":1702566374000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/fullarticle\/2805471"}},"subtitle":["A Randomized Crossover Trial"],"short-title":[],"issued":{"date-parts":[[2023,6,1]]},"references-count":55,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2023,6,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamanetworkopen.2023.16161","relation":{},"ISSN":["2574-3805"],"issn-type":[{"value":"2574-3805","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,6,1]]}}}