{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T07:03:47Z","timestamp":1775027027993,"version":"3.50.1"},"reference-count":24,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2020,4,28]],"date-time":"2020-04-28T00:00:00Z","timestamp":1588032000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Surgical Oncology"],"published-print":{"date-parts":[[2020,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Lymph node metastasis (LN+) is a prognostic factor in appendiceal cancers, but predictors and outcomes for LN+\u2009 in mucinous appendiceal adenocarcinoma (MAC) remain poorly defined.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Patients were identified from the 2010 to 2016 NCDB who underwent surgical resection as first\u2010line management for Stage I\u2010III mucinous appendiceal cancer. A LN+ risk\u2010score model was developed using multivariable regression on a training data set and internally validated using a testing data set. Three\u2010year overall survival (OS) was analyzed by Cox proportional hazards regression.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of 1158 patients, LN+ (N\u2009=\u2009244, 21.1%) patients were more likely to have higher pT group and grade of disease, lymphovascular invasion (LVI), and positive margins on univariate analyses. Predictive factors associated with LN+ on multivariable analysis included positive surgical margins (odds ratio [OR] 3.00, <jats:italic>P<\/jats:italic>\u2009&lt;.0001), higher grade (moderately differentiated: OR, 2.16, <jats:italic>P<\/jats:italic>\u2009&lt;\u2009.0001; poorly or undifferentiated: OR, 3.07, <jats:italic>P<\/jats:italic>\u2009&lt;\u2009.0001), and LVI (OR, 7.28, <jats:italic>P<\/jats:italic>\u2009&lt;\u2009.0001). A validated risk\u2010score model using these factors was developed with good performance (AUC 0.749). LN+ patients had a worse 3\u2010year OS compared with LN\u2212 patients (17.4% vs 82.6%, hazard ratio 1.96, <jats:italic>P<\/jats:italic>\u2009=\u2009.001).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>LN+ is associated with worse survival in patients with MAC. A risk\u2010score model using margin status, LVI, and grade can accurately risk stratify patients for LN+.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jso.25963","type":"journal-article","created":{"date-parts":[[2020,4,29]],"date-time":"2020-04-29T04:31:15Z","timestamp":1588134675000},"page":"399-406","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Predictors of lymph node metastases in patients with mucinous appendiceal adenocarcinoma"],"prefix":"10.1002","volume":"122","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7812-9627","authenticated-orcid":false,"given":"Adrienne B.","family":"Shannon","sequence":"first","affiliation":[{"name":"Department of Surgery Hospital of the University of Pennsylvania  Philadelphia Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Drew","family":"Goldberg","sequence":"additional","affiliation":[{"name":"Perelman School of Medicine University of Pennsylvania  Philadelphia Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yun","family":"Song","sequence":"additional","affiliation":[{"name":"Department of Surgery Hospital of the University of Pennsylvania  Philadelphia Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emily C.","family":"Paulson","sequence":"additional","affiliation":[{"name":"Department of Surgery Corporal Michael J. Crescenz VA Medical Center, University of Pennsylvania  Philadelphia Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert E.","family":"Roses","sequence":"additional","affiliation":[{"name":"Department of Surgery Hospital of the University of Pennsylvania  Philadelphia Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Douglas L.","family":"Fraker","sequence":"additional","affiliation":[{"name":"Department of Surgery Hospital of the University of Pennsylvania  Philadelphia Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rachel R.","family":"Kelz","sequence":"additional","affiliation":[{"name":"Department of Surgery Hospital of the University of Pennsylvania  Philadelphia Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John","family":"Miura","sequence":"additional","affiliation":[{"name":"Department of Surgery Hospital of the University of Pennsylvania  Philadelphia Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giorgos C.","family":"Karakousis","sequence":"additional","affiliation":[{"name":"Department of Surgery Hospital of the University of Pennsylvania  Philadelphia Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2020,4,28]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11605-014-2726-7"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00384-019-03387-y"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-018-24540-7"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0035-1564433"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejso.2017.06.015"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejso.2018.02.245"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1245\/s10434-012-2238-1"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jss.2015.03.051"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1245\/s10434-011-1903-0"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1245\/s10434-015-4415-5"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1097\/MPA.0b013e3181ebb2a5"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1245\/s10434-016-5632-2"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamcollsurg.2017.01.056"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000017332"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0000000000003501"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10434-004-1161-5"},{"key":"e_1_2_7_18_1","unstructured":"American College of Surgeons.National cancer database\u2014data dictionary PUF.http:\/\/ncdbpuf.facs.org\/node\/259?q=print\u2010pdf\u2010all. 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