Incidence of Appendiceal Malignancies in Sweden Between 1970 and 2012
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ORIGINAL SCIENTIFIC REPORT
Incidence of Appendiceal Malignancies in Sweden Between 1970 and 2012 Joel Johansson1
•
Roland E. Andersson1,2 • Kalle Landerholm1,2 • Stefan Rede´en2,3
Accepted: 16 August 2020 Ó Socie´te´ Internationale de Chirurgie 2020
Abstract Background There is limited knowledge about the epidemiology of the major histological subtypes of appendiceal malignancy: adenocarcinoma and neuroendocrine neoplasm of the appendix (A-NEN). The aims of this national cohort study were to assess the prevalence, incidence and trends of appendiceal malignancies in Sweden. Method All individuals who underwent appendicectomy and all diagnosed with appendiceal malignancy from 1970 to 2012 were identified from the National Patient Register and the Swedish Cancer Registry. Demographic data of the background population were obtained from Statistics Sweden. The incidence rate (IR) and the prevalence of appendiceal malignancy per performed appendicectomy were calculated. Results We identified 3774 patients with appendiceal malignancy. IR of A-NEN was 5.8/106 person-years with a peak of 8.4/106 at age 20–30 years, whereafter it plateaued at a somewhat lower level. IR for adenocarcinoma was 3.7/106 person-years, starting at a very low level among the youngest and increasing to 15.4/106 at age 80–89 years. The IR of adenocarcinoma increased from 2.6/106 in 1970–1979 to 5.4/106 in 2010–2012. The IR of A-NEN was stable during the study period. The prevalence per appendicectomy was low for both types of malignancies among the young but increased with age, most dramatically for adenocarcinoma. There was a trend during the study period towards more extensive surgery. Conclusion Adenocarcinoma is most common and increasing in the elderly, whereas A-NEN affects all ages with a peak in young age. This peak probably reflects removal of occult A-NEN due to the higher appendicectomy frequency in the young.
Introduction
Presented to the Swedish Surgical Society Congress, Malmo¨, Sweden, August 2016. & Stefan Rede´en [email protected] 1
Department of Surgery, County Hospital Ryhov, Jo¨nko¨ping, Sweden
2
Department of Biomedical and Clinical Sciences, Linko¨ping University, Linko¨ping, Sweden
3
Department of Surgery, Linko¨ping University Hospital, 581 85 Linko¨ping, Sweden
Malignancies of the vermiform appendix are rare and heterogeneous. The two predominant histopathological subtypes are appendiceal neuroendocrine neoplasms (ANEN) and adenocarcinoma, both with distinct biological behaviour [1, 2]. Current knowledge about the epidemiology of these malignancies is scarce. The estimated incidence of primary appendiceal malignancies varies enormously between 0.02 and 9.7 per million person-years in reports from USA, Iceland and the Netherlands [3–9]. There are indications that the incidence of both A-NEN and adenocarcinoma of
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the appendix has increased over the last decades [4, 5, 9, 10]. The majority of patients with appendiceal malignancies present with acute abdomen and many of them wit
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