Prognostic factors of primary small bowel adenocarcinoma: Univariate and multivariate analysis
Prognostic factors of primary small bowel adenocarcinoma: Univariate and multivariate analysis
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DOI：
10.1007/s00268-005-7898-6
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发表时间：
2006-03-01
影响因子：
2.6
通讯作者：
Chen, MF
中科院分区：
文献类型：
--
作者：
Wu, TJ;Yeh, CN;Chen, MF
背景：小肠腺癌比食道、胃和结直肠的恶性肿瘤相对较少见。在小肠腺癌，各种预后因素影响的无病状态和总生存率。材料和方法：80例患者被诊断为小肠腺癌和治疗在我院1983年和2003年之间进行了回顾性分析。结果：患者包括40名男性和40名女性，年龄范围为15至93岁（中位数：62岁）。只有51.3%的患者术前通过内镜活检被准确证实为恶性肿瘤。60例患者接受了手术治疗，其中45例患者获得了根治性切除。随访时间范围为2.5至229.7个月，中位时间为9.1个月。所有患者的累积1年、3年和5年生存率（不包括3例术后即刻死亡的患者）分别为43.6%、22.8%和17.5%。所有43例根治性切除患者（不包括2例术后即刻死亡的患者）的累积1、3和5年无病生存率分别为54.9%、30.5%和27.4%。多因素分析和考克斯比例风险分析显示，早期肿瘤分期（I期和II期）和根治性切除是影响总生存率的两个独立因素。淋巴结转移是唯一的独立因素预测不良的无病生存在接受根治性切除术的患者。结论：小肠腺癌的预后不良可能与延误诊断和治疗的疾病。根治性切除是小肠腺癌外科治疗的目标。疾病出现时的淋巴结转移预示着治愈性手术治疗后的肿瘤复发和远处转移。
Background: Adenocarcinoma of the small bowel is relatively less common than malignancies of the esophagus, stomach, and colorectum. In small bowel adenocarcinoma, various prognostic factors influence the disease-free status and overall survival rates.Materials and Methods: Eighty patients who were diagnosed with small bowel adenocarcinoma and treated at our institute between 1983 and 2003 were retrospectively reviewed.Results: The patients included 40 men and 40 women with an age range of 15 to 93 years (median: 62 years). Only 51.3% of patients were accurately proved preoperatively to have a malignancy by endoscopic biopsy. Sixty patients underwent surgical treatment, and 45 of those patients had curative resection. The follow-up period ranged from 2.5 to 229.7 months, with a median of 9.1 months. The cumulative 1-, 3-, and 5-year survival rates for all patients (excluding 3 patients who died in the immediate postoperative period) were 43.6%, 22.8%, and 17.5%, respectively. The cumulative 1-, 3-, and 5-year disease-free survival rate for all 43 patients with curative resection (excluding 2 patients who died in the immediate postoperative period) was 54.9%, 30.5%, and 27.4%, respectively. Meanwhile, multivariate analysis with Cox proportional hazards analysis demonstrated that earlier tumor stages (stages I and II) and curative resection were two independent factors influencing favorable overall survival. Lymph node metastasis was the only independent factor predicting poor disease-free survival in patients undergoing curative resection.Conclusions: Poor prognosis of small bowel adenocarcinoma may be related to a delay in the diagnosis and treatment of the disease. Curative resection is the aim of surgical treatment for small bowel adenocarcinoma. Lymph node metastasis at presentation of the disease predicts tumor recurrence and distant metastasis after curative surgical treatment.