eP447 - Examining the Role for Surgery in the Management of Intestinal Extramedullary Plasmacytoma

ePoster Presenter(s)

• AD

  Austin Richard Dosch, MD PhD

  Fellow
  Washington University School of Medicine
  St Louis, Missouri, United States

  All of the relevant financial relationships listed below have been mitigated.
  This individual has no financial relationships with ineligible companies.

Author(s)

• 

  Oluseye Oduyale, MD

  Resident Physician
  Washington University School of Medicine in St. Louis
  Washington University School of Medicine in St. Louis
  St. Louis, MO, United States

  All relevant financial disclosures have been managed and will be listed below.
  This individual has no financial relationships with ineligible companies.
• AE

  Ahmed Eltahir, MD

  Resident Physician
  Washington University in St. Louis
  Washington University in St. Louis
  St. Louis, MO, United States

  All relevant financial disclosures have been managed and will be listed below.
  This individual has no financial relationships with ineligible companies.
• HN

  Harika Nalluri-Butz, MD

  Colorectal Surgery Fellow
  Washington University in St Louis
  St Louis, Missouri, United States

  Disclosure information not submitted.
• 

  Lindsey Zhang, MD

  Fellow
  Washington University School of Medicine
  St Louis, MO, United States

  All of the relevant financial relationships listed below have been mitigated.
  This individual has no financial relationships with ineligible companies.
• 

  Kerri A. Ohman, MD, FACS (she/her/hers)

  Assistant Professor
  Washington University School of Medicine
  Saint Louis, MO, United States

  All relevant financial disclosures have been managed and will be listed below.
  This individual has no financial relationships with ineligible companies.
• PW

  Paul Wise, MD FACS

  Professor of Surgery
  Washington University School of Medicine
  St Louis, Missouri, United States

  Disclosure information not submitted.
• MS

  Matthew Silviera, MD MS

  Assistant Professor of Surgery
  Washington University School of Medicine
  St Louis, Missouri, United States

  All relevant financial disclosures have been managed and will be listed below.
  This individual has no relevant relationships with ineligible companies.
• 

  Steven Hunt, MD

  Professor of Surgery
  Washington University School of Medicine
  St Louis, Missouri, United States

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  This individual has no financial relationships with ineligible companies.
• 

  Matthew Mutch, MD, FACS, FASCRS

  Professor of Surgery
  Washington University School of Medicine
  Washington University School of Medicine
  St Louis, Missouri, United States

  All relevant financial disclosures have been managed and will be listed below.
  This individual has no financial relationships with ineligible companies.

Senior Author(s)

• WC

  William Chapman, Jr, MD

  Assistant Professor
  Washington University in St. Louis
  St. Louis, Missouri, United States

  Disclosure information not submitted.

Purpose/Background: Extramedullary (EM) plasmacytoma is a rare clinical entity commonly treated with definitive radiation therapy. However, the optimal management of intestinal EM plasmacytoma (small bowel, large bowel, and rectum) remains unknown. Given the considerable challenges in administering radiation treatment for gastrointestinal malignancies, we hypothesized that surgery would be more frequently performed for intestinal EM plasmacytoma than other primary disease sites. Furthermore, we aimed to determine if outcomes were equivalent for patients undergoing surgery compared to other treatment modalities for these rare malignancies.Methods/Interventions: The National Cancer Database (NCDB) was queried for cases of EM plasmacytoma. Patients with unknown treatment status or missing data for surgery, radiation, or chemotherapy were excluded from the analysis. Similarly, patients with an unknown primary tumor site or ICD-O-3 disease site of leukemia were excluded from the analysis. Statistical differences among categorical variables were analyzed using Fisher’s exact test. Kaplan-Meier estimate was used to compute survival curves and pairwise comparison of survival data were performed using log-rank (Mantel-Cox) test. Analysis was performed using SAS Studio (Cary, NC) and GraphPad Prism (Boston, MA).Results/Outcomes: 2114 patients with EM plasmacytoma were included in the analysis. 102 (4.8%) patients had primary intestinal EM plasmacytoma. Of these, the colon was the most common site of intestinal EM plasmacytoma, representing 48% of all intestinal cases. Intestinal EM plasmacytoma was considerably more likely to be treated with surgical resection than other non-intestinal primary sites (77.5% vs 44.5%, p < 0.0001). Among intestinal EM plasmacytoma, no significant difference in overall survival was observed between patients undergoing surgery compared with other treatment modalities (log-rank p=0.19, Figure 1). Similarly, there were no significant differences in overall survival between intestinal EM plasmacytoma and EM plasmacytoma of other primary disease sites (p=0.84).Conclusion/

Discussion: These data demonstrate that intestinal EM plasmacytoma is treated more commonly with surgery nationwide and that resection has equivalent survival outcomes to other treatment modalities. Our data suggest that upfront surgical resection is adequate treatment for intestinal EM plasmacytoma, however further research is needed to clearly delineate the optimal management of these rare gastrointestinal tumors.Figure 1: Survival curves for intestinal extramedullary plasmacytoma treated with surgery (red) or no surgery (blue).