This study extensively evaluated the factors influencing survival in patients diagnosed with AC and MAC. The results revealed significant clinical, demographic, and biological differences between the two tumor subtypes. These distinctions highlight the need for tailored patient management and treatment approaches based on tumor subtypes.

Compared to AC, MAC is often diagnosed at a younger age and is more common in females. This suggests that MAC may have a distinct biological profile and a less aggressive clinical course. Conversely, AC is more frequently observed in older males. Similar findings have been reported in the literature, where MAC is described as predominantly affecting younger populations and females. Recognizing these differences is crucial for diagnosis and treatment planning. [4, 5].

Both AC and MAC showed that patients over the age of 50 had a significantly higher risk of mortality compared to younger patients. Univariate and multivariate analyses revealed that patients aged above 50 had considerably higher hazard ratios (HR) compared to those aged 50 and below (p < 0.001). This underscores the significant impact of age on the prognosis of appendiceal cancers. Our analysis also indicated that AC patients were significantly older than MAC patients, with a higher prevalence of AC observed in individuals above 50 years of age. These findings suggest that further research is necessary to explore the underlying causes of these age-related differences and their effects on prognosis. Literature corroborates that AC typically presents in males aged 62–65 on average, while MAC has a mean presentation age of 60, with a slight female predominance but no definitive gender bias [5,6,7].

Although statistical significance was not observed, black race was more frequently associated with the adenocarcinoma group compared to the mucinous carcinoma group. The influence of race on appendiceal cancer prognosis remains unclear; however, further studies with larger sample sizes and molecular-level investigations are needed. In both univariate and multivariate analyses, no significant relationship was found between race and outcomes (p > 0.05) [8].

There are no studies in the literature addressing the impact of marital status on appendiceal cancers. Our analysis revealed that being married had a positive impact on the survival of patients with appendiceal cancer. Within the groups, the rate of married individuals was statistically higher in the MAC group compared to the AC group. Both AC and MAC showed that unmarried patients had a significantly higher mortality risk compared to married patients (p < 0.001, p < 0.003, respectively). These findings suggest that social support and marital factors may play a role in patient outcomes.

Survival analysis showed worse prognoses for AC compared to MAC. Kaplan–Meier curves and multivariate analyses indicated significantly higher survival risks for AC, suggesting a more aggressive biological behavior and poorer outcomes. Despite being diagnosed at more advanced stages, MAC demonstrated better survival rates, supporting its distinct biological characteristics [4, 9].

Tumor grade and stage have a significant impact on survival for both tumor types. Tumors with lower grades and earlier stages were associated with better survival rates. Notably, the survival risk increased dramatically in patients with Grade III and Stage IV tumors. Higher tumor grades (Grade II and III) were significantly associated with higher hazard ratios (HR) compared to Grade I in both univariate and multivariate analyses (p < 0.001). This underscores the importance of tumor histologic grade in determining patient prognosis. These findings further emphasize the critical role of early diagnosis and treatment. Literature also indicates that patients diagnosed at advanced stages tend to have worse prognoses and limited responses to treatment [10,11,12].

However, there are notable differences in histologic grades between AC and MAC. Grade I tumors were more common in MAC, whereas Grade II and III tumors were more prevalent in AC. This suggests that histologic grade is a significant factor in predicting prognosis for appendiceal cancer. Additionally, histologic grade appears to be a stronger prognostic factor for AC than for MAC. The mortality risk associated with AC was found to be higher than that of MAC. These results emphasize the critical role of histologic grade in predicting patient prognosis [13,14,15].

The findings indicate that cancer stage significantly affects survival outcomes for appendiceal cancer patients. For both adenocarcinoma and mucinous carcinoma, higher cancer stages (Stages II, III, and IV) were associated with increased mortality risk (p < 0.001). Although there was no difference in Stage 0, Stages I and II were more frequently observed in AC, while Stage IV was more common in MAC. The likelihood of presenting with Stage IV disease was 2.5 times higher in MAC compared to AC (47% vs. 19%, respectively). While this finding aligns with previous reports in the literature, our analysis showed an even higher rate. Stage III disease was relatively rare in MAC (9%) but more pronounced in AC (19.4%). These findings, consistent with the literature, suggest that MAC has a higher tendency for peritoneal metastasis rather than lymphatic metastasis. These results highlight the importance of cancer stage in treatment planning and prognosis prediction [12, 14].

The positive effects of surgery and chemotherapy on survival were clearly demonstrated in this study. Surgical treatment emerged as the most significant factor in improving survival for both groups. The rate of surgical intervention was significantly higher in the AC group compared to the MAC group (p < 0.001). For both AC and MAC, not undergoing surgery was associated with a significantly higher risk of mortality (p < 0.001).

Furthermore, chemotherapy played a particularly beneficial role in improving survival in the adenocarcinoma group. On the other hand, the impact of radiotherapy on survival was found to be more limited, a finding consistent with the literature. The optimal combination of treatment modalities, especially for more aggressive tumor types like adenocarcinoma, has the potential to improve patient prognosis [1, 2, 10, 16,17,18].

This study demonstrated significant clinical and biological differences between AC and MAC, highlighting the need for subtype-specific management strategies. Although MAC patients exhibited better survival rates, they were generally diagnosed at more advanced stages. These findings emphasize the importance of individualized treatment planning based on tumor subtype. Surgery and chemotherapy were clearly identified as the most significant factors positively influencing survival. Prognostic factors, such as age, gender, and tumor characteristics, should be carefully considered in clinical decision-making. These results offer valuable insights for improving patient outcomes in clinical practice. Nevertheless, prospective studies involving larger patient populations are necessary to enhance the generalizability of these findings.