Adenocarcinoma of the small intestine: a multi-institutional study of 197 surgically resected cases
Adenocarcinoma of the small intestine: a multi-institutional study of 197 surgically resected cases
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DOI：
10.1016/j.humpath.2010.01.006
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发表时间：
2010-08-01
期刊：
影响因子：
3.3
通讯作者：
Hong, Seung-Mo
中科院分区：
文献类型：
--
作者：
Chang, Hee-Kyung;Yu, Eunsil;Hong, Seung-Mo
小肠腺癌是一种罕见的恶性肿瘤，其临床病理特征尚未明确。收集韩国22家机构的197例小肠腺癌病例，采用单因素和多因素分析评估影响小肠腺癌患者预后的临床病理因素。患者平均年龄为59岁，男女比例为1.7:1。肿瘤位于十二指肠108例（55%），空肠59例（30%），回肠30例（15%）。 23例（12%）中观察到诱发因素，其中散发性腺瘤17例，Peutz-Jeghers综合征3例，Meckel憩室2例，克罗恩病1例。 31例（16%）发现同时或异时恶性肿瘤，其中结直肠癌13例，胃癌10例。约 90% 的肿瘤被分类为 pT3（63 例）或 pT4（112 例）。所有小肠腺癌患者的中位生存时间为 39.7 个月。与不伴有散发性腺瘤的小肠腺癌相比，伴有腺瘤的小肠腺癌分化程度更高（P < .0001），息肉样生长模式更多（P < .0001），pT分类更低（P < .0001），神经周围浸润更少（P = .01），淋巴浸润更少（P = .03）。伴有散发性腺瘤的小肠腺癌患者 (77%) 的 5 年生存率明显高于无散发性腺瘤的患者 (38%，P = .02)。通过单变量分析，根据 pT 分类 (P = .003)、淋巴结转移 (P < .0001)、远端位置（空肠癌和回肠癌）(P = .003)、腹膜后肿瘤种植 (P < .0001)、血管侵犯 (P = .007)，小肠腺癌患者的生存率存在显着差异。 淋巴管侵犯 (P = .001)、瘤周发育不良 (P = .004) 和放射治疗 (P = .006)。通过多变量分析，淋巴结转移 (P = .01) 和远端位置 (P = .003) 是预后较差的独立预测因素。总之，（1）小肠腺癌确诊时已处于晚期；因此，需要制定早期检测策略。 (2)有腺瘤成分的小肠腺癌患者比无腺瘤成分的小肠腺癌患者有更好的生存率。 (3)淋巴结转移和肿瘤远端位置(空肠和回肠)是最重要的独立预后因素。 (C) 2010 Elsevier Inc. 保留所有权利。
Small intestinal adenocarcinoma is a rare malignant neoplasm, and its clinicopathologic characteristics have not been well elucidated. A total of 197 small intestinal adenocarcinoma cases were collected from 22 institutions in South Korea and were evaluated for clinicopathologic factors that affect the prognosis of small intestinal adenocarcinoma patients using univariate and multivariate analyses. The mean patient age was 59 years, and the male-to-female ratio was 1.7:1. Tumors were located in the duodenum of 108 cases (55%), the jejunum in 59 (30%), and the ileum in 30 (15%). Predisposing conditions were observed in 23 cases (12%), including 17 cases with sporadic adenomas, 3 with Peutz-Jeghers syndrome, 2 with Meckel diverticulum, and 1 with Crohn disease. Synchronous or metachronous malignant tumors were identified in 31 cases (16%), including 13 colorectal and 10 stomach cancers. About 90% of tumors were classified as either pT3 (63 cases) or pT4 (112 cases). The median survival time for all small intestinal adenocarcinoma patients was 39.7 months. Compared with small intestinal adenocarcinomas without accompanying sporadic adenomas, small intestinal adenocarcinomas with accompanying adenomas were more well differentiated (P < .0001), with a more polypoid growth pattern (P < .0001), a lower pT classification (P < .0001), less perineural invasion (P = .01), and less lymphatic invasion (P = .03). Small intestinal adenocarcinoma patients with associated sporadic adenomas (77%) had a significantly better 5-year survival rate than those without sporadic adenomas (38%, P = .02). By univariate analysis, small intestinal adenocarcinoma patients had significantly different survival based on pT classification (P = .003), lymph node metastasis (P < .0001), distal location (jejuna] and ileal carcinomas) (P = .003), retroperitoneal tumor seeding (P < .0001), vascular invasion (P = .007), lymphatic invasion (P = .001), peritumoral dysplasia (P = .004), and radiation therapy (P = .006). By multivariate analysis, lymph node metastasis (P = .01) and distal location (P = .003) were independent predictors of a worse prognosis. In conclusion, (1) small intestinal adenocarcinomas are diagnosed at an advanced disease stage; therefore, the development of strategies for detection at an earlier stage is needed. (2) Small intestinal adenocarcinoma patients with an adenomatous component had a better survival than those without an adenomatous component. (3) Lymph node metastasis and distal location (jejunum and ileum) of tumor are the most important independent prognostic factors. (C) 2010 Elsevier Inc. All rights reserved.