Department of Pathology, Kosin University College of Medicine, Pusan, 602-702 South Korea.
Hum Pathol. 2010 Aug;41(8):1087-96. doi: 10.1016/j.humpath.2010.01.006. Epub 2010 Mar 23.
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 (jejunal 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.
小肠腺癌是一种罕见的恶性肿瘤，其临床病理特征尚未得到很好的阐明。本研究共收集了韩国 22 家机构的 197 例小肠腺癌病例，并通过单因素和多因素分析评估了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%）存在潜在疾病，包括 17 例散发性腺瘤、3 例 Peutz-Jeghers 综合征、2 例 Meckel 憩室和 1 例克罗恩病。31 例（16%）同时或异时存在恶性肿瘤，包括 13 例结直肠癌和 10 例胃癌。约 90%的肿瘤分为 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。与无伴随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<0.0001），具有更多的息肉样生长模式（P<0.0001），更低的 pT 分类（P<0.0001），更少的神经周围侵犯（P=0.01），更少的淋巴血管侵犯（P=0.03）。伴有散发性腺瘤的小肠腺癌患者（77%）5 年生存率明显高于无散发性腺瘤的患者（38%，P=0.02）。单因素分析显示，小肠腺癌患者的生存情况因 pT 分类（P=0.003）、淋巴结转移（P<0.0001）、肿瘤部位（空肠和回肠癌）（P=0.003）、腹膜后肿瘤播散（P<0.0001）、血管侵犯（P=0.007）、淋巴血管侵犯（P=0.001）、肿瘤周围发育不良（P=0.004）和放疗（P=0.006）而存在显著差异。多因素分析显示，淋巴结转移（P=0.01）和肿瘤部位（P=0.003）是预后不良的独立预测因素。总之，（1）小肠腺癌患者在疾病晚期才被诊断出来，因此需要开发更早阶段的检测策略。（2）伴有腺瘤成分的小肠腺癌患者的生存率高于无腺瘤成分的患者。（3）淋巴结转移和肿瘤部位（空肠和回肠）是最重要的独立预后因素。
