Appendiceal Cancer in the National Cancer Database: Increasing Frequency, Decreasing Age, and Shifting Histology

Area of Science:

• Oncology
• Gastroenterology
• Epidemiology

Background:

• Nonoperative management of acute appendicitis is becoming more common.
• Previous studies suggest a high incidence of appendiceal cancer in interval appendectomy specimens.
• This study investigates national trends in appendiceal cancer incidence and histology.

Purpose of the Study:

• To analyze national trends in appendiceal cancer incidence and histology from 2004 to 2017.
• To compare appendiceal cancer trends with other right-sided colon cancers.
• To identify demographic factors associated with appendiceal cancer trends.

Main Methods:

• Utilized the National Cancer Database (NCDB) for patients aged 18+ diagnosed with right-sided colon or appendiceal cancer from 2004-2017.
• Compared appendiceal cancer incidence and histology trends against other right-sided colon cancers.
• Employed logistic regression to assess temporal trends, adjusting for patient demographics and comorbidities.

Main Results:

• Appendiceal cancer rates significantly increased relative to other right-sided colon cancers between 2004 and 2017 (OR 2.56).
• This rise was observed across all age groups, with a notable increase in patients aged 40-49.
• Appendiceal carcinoid tumors also increased significantly (OR 1.70), with the largest rise in patients under 40.

Conclusions:

• Appendiceal cancer incidence has increased, driven by a rise in carcinoid tumors, particularly in patients 49 years or younger.
• The findings suggest that careful monitoring is warranted for patients with appendicitis managed nonoperatively.
• Further research into the etiology and optimal management of appendiceal cancers is needed.