Adenocarcinoma of the small bowel: Presentation, prognostic factors, and outcome of 217 patients
Adenocarcinoma of the small bowel: Presentation, prognostic factors, and outcome of 217 patients
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DOI：
10.1002/cncr.20404
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发表时间：
2004-08-01
期刊：
影响因子：
6.2
通讯作者：
Ajani, J
中科院分区：
文献类型：
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作者：
Dabaja, BS;Suki, D;Ajani, J
原发性小肠腺癌是一种罕见的肿瘤，据作者所知，迄今为止很少有研究涉及这一主题。方法在本研究中，回顾性分析了217例小肠腺癌患者的临床表现、预后因素、治疗方式，患者的中位年龄为55岁，男性133例（61%）。113例（52%）患者的肿瘤起源于十二指肠，54例（25%）患者的肿瘤起源于空肠，28例（13%）患者的肿瘤起源于回肠，22例（10%）患者的肿瘤起源于非指定部位。患有近端肿瘤的患者大部分使用内窥镜检查进行诊断（即，46/108 [43%]），而28例远端肿瘤患者中有16例（57%）剖腹手术能够诊断。根据TNM分期，9例（4%）患者为I期疾病，43例（20%）患者为II期疾病，86例（39%）患者为III期疾病，75例（35%）患者为IV期疾病。肝脏是44例（59%）患者中最常见的转移部位。146例（67%）患者接受了癌症导向手术，包括36例（17%）患者接受的维普莱手术。中位总生存期为20个月。5年总生存率为26%。通过单变量分析，癌症定向手术、早期疾病和淋巴结受累率与总生存率显著相关。然而，在多变量分析中，只有肿瘤定向手术和淋巴结受累率是总生存率的独立预测因素（校正率比= 0.14; 95%置信区间[95% CI]，0.04-0.46;P= 0.001和校正率比= 0.25; 95% CI，0.12-0.53; P< 0.001）.结论对于非转移性肿瘤患者，手术治疗效果最好。由于癌症定向手术在一级中心的发病率和死亡率较高，因此这些患者应转诊至三级中心进行充分治疗。癌症2004年。© 2004美国癌症协会。
BACKGROUNDPrimary adenocarcinoma of the small bowel is a rare neoplasm, and to the authors' knowledge, few studies to date have addressed the topic.METHODSIn the current study, the records of 217 patients with small bowel adenocarcinoma were reviewed retrospectively for the presentation, prognostic factors, treatment modalities, and outcome.RESULTSThe median age of the patients was 55 years and there were 133 (61%) males. Tumors originated in the duodenum in 113 (52%) patients, the jejunum in 54 (25%) patients, the ileum in 28 (13%) patients, and in nonspecified sites in 22 (10%) patients. Patients with proximal tumors were diagnosed for the most part using endoscopy (i.e., 46 of 108 [43%]), whereas laparotomy enabled diagnosis in 16 of 28 (57%) patients with distal tumors. Based on TNM staging, 9 (4%) patients had Stage I disease, 43 (20%) patients had Stage II disease, 86 (39%) patients had Stage III disease, and 75 (35%) patients had Stage IV disease. The liver was the most common site of metastasis in 44 (59%) patients. Cancer‐directed surgery was performed in 146 (67 %) patients, including the Whipple procedure in 36 patients (17%). The median overall survival time was 20 months. The 5‐year overall survival rate was 26%. Cancer‐directed surgery, early‐stage disease, and lymph node involvement ratio were significantly associated with overall survival by univariate analysis. However, only cancer‐directed surgery and lymph node involvement ratio were independent predictors of overall survival in a multivariate analysis (adjusted rate ratio = 0.14; 95% confidence interval [95% CI], 0.04–0.46;P= 0.001 and adjusted rate ratio = 0.25; 95% CI, 0.12–0.53;P< 0.001, respectively).CONCLUSIONSPerforming an oncologic surgery resulted in the best outcome in patients with nonmetastatic disease. Because cancer‐directed surgery is associated with high morbidity and mortality in primary centers, these patients should be referred to a tertiary center for adequate treatment. Cancer 2004. © 2004 American Cancer Society.