E106: Clinicopathologic Features, Treatment Patterns And Outcomes of Patients with Extra-appendiceal Goblet Cell Adenocarcinomas

ePoster Abstract Author(s)

Baqir H. Jafry, MD (he/him/his)

Post Doctoral Research Fellow
Department of Internal Medicine, University of Texas SouthWestern Medical Center
Dallas, Texas, United States

Submitter(s)

Baqir H. Jafry, MD (he/him/his)

Post Doctoral Research Fellow
Department of Internal Medicine, University of Texas SouthWestern Medical Center
Dallas, Texas, United States

Author(s)

Baqir H. Jafry, MD (he/him/his)

Post Doctoral Research Fellow
Department of Internal Medicine, University of Texas SouthWestern Medical Center
Dallas, Texas, United States
AM

Allante Milsap, n/a

Medical Student
University of Texas SouthWestern Medical Center, Texas, United States
MB

Munir H. Buhaya, MD

Assistant Instructor
Department of Surgery, University of Texas SouthWestern Medical Center, United States
Patricio M. Polanco, MD

Associate Professor
Department of Surgery, University of Texas Southwestern Medical Center
Dallas, Texas, United States
SK

Syed Kazmi, MD

Associate Professor
Department of Internal Medicine, University of Texas SouthWestern Medical Center, Texas, United States

Introduction: Goblet cell adenocarcinoma (GCA) is an exceptionally rare tumor that most commonly arises in the appendix. Primary extra-appendiceal GCAs (EGCA) are infrequently reported in literature and their clinical behavior is poorly understood. We aim to describe the clinico-pathological features of EGCA and their treatment utilization pattern and clinical outcomes.

Methods: Patients diagnosed with GCA between 2004-2015 were identified from the National Cancer Database using ICD-03 morphology and topography code 8243. Patients with unknown follow-up and primary site code C181 (appendix) were excluded. Univariate analysis was performed, and predictors of overall survival (OS) were identified using Cox proportional hazard models and Kaplan Meier Curves.

Results: We identified 246 patients (51% males, 82% Whites). The mean age of population was 63 (sd:13) years. The most common primary site was the colon (66%), followed by the small intestine (18%), rectum (9%), stomach (5%), rectosigmoid (2%), and gallbladder (1%). Among the cases originating from the colon, most tumors arose from cecum (51%), followed by ascending colon (19%), overlapping lesions of the colon (10%), sigmoid colon (6%), transverse colon (5%), hepatic flexure (1.2%) and descending colon (0.6%). The number of EGCA cases did not change significantly over time. Most patients had grade 3 (14%) and stage IV (12%) tumors. Lympho-vascular invasion was present in 43 cases (18%). Most patients underwent surgery (86%), among whom most underwent right hemicolectomy (36%). Among those who underwent right hemicolectomy, most patients had grade 2 tumors (17%). Patients with Grade 1 EGCA had a better 5-year OS compared to patients with Grade 2 EGCA and Grade 3 EGCA (61 vs 58 vs 17). Patients with negative surgical margins had a better 5-year OS compared to those with positive surgical margins (56 vs 23). Patients with EGCA originating in the Rectum had a better 5-year OS compared to those with EGCA originating from other sites. On Cox regression analysis, older age (HR:1.03; 95% CI: 1.02-1.05; P < 0.001), lymph node metastasis (HR:3.4; 95% CI: 2.3-5.3; P < 0.001), and positive surgical margins (HR:2.8; 95% CI: 1.9-4.1; P < 0.001) were all correlated with worse OS.

Conclusions: EGCA is an extremely rare disease that mostly originates in the colon. Among colonic GCA, most tumors belong to cecum. Most patients with EGCA undergo surgery. Patients with EGCA grade 1, rectal primary and with negative surgical margins have better survival outcomes while lymph node metastasis and positive surgical margins had worse survival.

Learning Objectives:

Describe patient characteristics and tumor characteristics of Extra-appendiceal Goblet Cell adenocarcinomas (E-GCA)
Describe treatment utilization among patients diagnosed with Extra-appendiceal Goblet Cell Adenocarcinomas (E-GCA)
Compare survival outcomes of different grades and sites of Extra-appendiceal Goblet Cell Adenocarcinomas (E-GCA)