Increased risk of malignancy for patients older than 40 years with appendicitis and an appendix wider than 10 mm on computed tomography scan: A post hoc analysis of an EAST multicenter study

Background: The incidence of underlying malignancy in appendicitis ranges between 0.5% and 1.7%. We sought to identify the subset of patients with appendicitis who are at increased risk of appendiceal malignancy.Methods: Using the Eastern Association for the Surgery of Trauma Multicenter Study of the Treatment of Appendicitis in America: Acute, Perforated, and Gangrenous database, we included all patients from 28 centers undergoing immediate, delayed, or interval appendectomy between 2017 and 2018. Univariate then multivariable analyses were performed to compare patients with and without malignancy and to identify independent demographic, clinical, laboratory, and/or radiological predictors of malignancy. Akaike information criteria for regression models were used to evaluate goodness of fit.Results: A total of 3,293 patients were included. The median age was 38 (27-53) years, and 46.5% were female patients. On pathology, 48 (1.5%) had an underlying malignancy (adenocarcinoma [60.4%], neuroendocrine [37.5%], and lymphoma [2.1%]). Patients with malignancy were older (56 [34.5-67] vs 37 [27-52] years, P .001), had longer duration of symptoms before presentation (36-41 vs 18-23 hours, P = .03), and were more likely to have a phlegmon on imaging (6.3% vs 1.3%, P = .03). Multivariable analyses showed that an enlarged appendiceal diameter was independently associated with malignancy (odds ratio = 1.06, 95% confidence interval = 1.01-1.12; P = .01). The incidence of malignancy in patients 10 mm. The corresponding risk ratio for that population was 3.03 (95% confidence interval: 1.24-7.42; P = .02).Conclusion: The combination of age 40 and an appendiceal diameter >10 mm is associated with a greater than 3-fold increased risk of malignancy in patients presenting with appendicitis. (c) 2020 Elsevier Inc. All rights reserved.

背景：阑尾炎患者潜在恶性肿瘤的发生率在0.5% - 1.7%之间。我们试图确定阑尾炎患者中阑尾恶性肿瘤风险增加的亚组。 方法：利用美国创伤外科东部协会关于阑尾炎治疗的多中心研究（急性、穿孔和坏疽性阑尾炎数据库），我们纳入了2017年至2018年间来自28个中心接受即刻、延迟或择期阑尾切除术的所有患者。首先进行单变量分析，然后进行多变量分析，以比较患有和未患恶性肿瘤的患者，并确定恶性肿瘤的独立人口统计学、临床、实验室和/或放射学预测因素。使用回归模型的赤池信息准则来评估拟合优度。 结果：共纳入3293名患者。中位年龄为38岁（27 - 53岁），46.5%为女性患者。在病理学检查中，48例（1.5%）患有潜在恶性肿瘤（腺癌[60.4%]、神经内分泌肿瘤[37.5%]和淋巴瘤[2.1%]）。患有恶性肿瘤的患者年龄更大（56岁[34.5 - 67岁]对比37岁[27 - 52岁]，P <.001），就诊前症状持续时间更长（36 - 41小时对比18 - 23小时，P =.03），并且在影像学检查中更有可能出现蜂窝织炎（6.3%对比1.3%，P =.03）。多变量分析显示，阑尾直径增大与恶性肿瘤独立相关（比值比 = 1.06，95%置信区间 = 1.01 - 1.12；P =.01）。阑尾直径>10mm的患者恶性肿瘤发生率为3.03%。该人群相应的风险比为3.03（95%置信区间：1.24 - 7.42；P =.02）。 结论：年龄≥40岁且阑尾直径>10mm的组合与阑尾炎患者恶性肿瘤风险增加3倍以上相关。（c）2020爱思唯尔公司。保留所有权利。