Is there a role for adjuvant therapy in resected adenocarcinoma of the small intestine
Is there a role for adjuvant therapy in resected adenocarcinoma of the small intestine
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DOI：
10.3109/02841860903490051
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发表时间：
2010-05-01
期刊：
影响因子：
3.1
通讯作者：
Wolff, Robert A.
中科院分区：
文献类型：
--
作者：
Overman, Michael J.;Kopetz, Scott;Wolff, Robert A.
背景辅助治疗对切除的小肠腺癌的益处尚未得到证实。我们进行了一项回顾性分析，以评估辅助治疗在明确定义的根治性切除小肠腺癌患者人群中的获益。材料和方法。我们确定了54例接受边缘阴性手术切除的小肠腺癌患者，并在德克萨斯大学进行了手术后评估。D.安德森癌症中心1990年至2008年。估计无病生存期（DFS）和总生存期（OS）。结果中位年龄为55岁，原发肿瘤部位为十二指肠67%，空肠20%，回肠13%。30名患者（56%）接受了辅助治疗，其中28名患者接受了全身化疗联合或不联合放疗，2名患者接受了单纯放疗。接受辅助治疗的患者的肿瘤分期和淋巴结转移率显著较高。治疗组之间的5年DFS和OS没有差异。在多变量分析中，辅助治疗的使用与DFS改善相关（HR 0.27; 95% CI 0.07-0.98，P = 0.05），但与OS无关（HR 0.47; 95% CI 0.13-1.62，P = 0.23）。在复发风险高的患者中（定义为淋巴结比率>= 10%），辅助治疗似乎改善了OS，P = 0.04，但没有改善DFS，P = 0.15。讨论根治性切除的小肠腺癌的辅助治疗与DFS的改善相关。这一发现强烈支持进一步研究这种肿瘤类型的辅助化疗。
Background. The benefit of adjuvant therapy for resected small bowel adenocarcinoma has not been proven. We undertook a retrospective analysis to evaluate the benefit of adjuvant therapy in a clearly defined patient population with curatively resected small bowel adenocarcinoma. Material and methods. We identified 54 patients with small bowel adenocarcinoma who underwent margin-negative surgical resection and were evaluated after surgery at the University of Texas, M. D. Anderson Cancer Center between 1990 and 2008. Disease-free survival (DFS) and overall survival (OS) were estimated. Results. Median age was 55 years and primary tumor site was duodenum in 67%, jejunum in 20%, and ileum in 13%. Thirty patients (56%) received adjuvant therapy consisting of systemic chemotherapy with or without radiation in 28 and radiation alone in two. Patients who received adjuvant therapy had significantly higher tumor stage and rate of lymph node involvement. Five-year DFS and OS did not differ between treatment groups. In multivariate analysis, the use of adjuvant therapy was associated with improved DFS (HR 0.27; 95% CI 0.07-0.98, P = 0.05) but not OS (HR 0.47; 95% CI 0.13-1.62, P = 0.23). In patients with a high risk of relapse (defined as a lymph node ratio >= 10%), adjuvant therapy appeared to improve OS, P = 0.04, but not DFS, P = 0.15. Discussion. The use of adjuvant therapy for curatively resected small bowel adenocarcinoma was associated with an improvement in DFS. This finding strongly supports further investigation of adjuvant chemotherapy in this tumor type.