小肠腺癌：分期不足且治疗不足？

Small bowel adenocarcinoma: understaged and undertreated?

机构信息

John Wayne Cancer Institute at Saint John's Health Center, Santa Monica, CA, USA.

出版信息

Ann Surg Oncol. 2010 Oct;17(10):2728-32. doi: 10.1245/s10434-010-1109-x. Epub 2010 May 11.

DOI:10.1245/s10434-010-1109-x

PMID:20458546

Abstract

BACKGROUND

Primary small bowel adenocarcinoma (SBA) is a rare, chemoresistant tumor with an aggressive clinical nature. Surgery is the mainstay of therapy, but the extent of lymph node (LN) recovery necessary for optimal care of jejunoileal SBA is unknown.

MATERIALS AND METHODS

The SEER database was queried to identify patients whose primary jejunoileal SBA was diagnosed between 1995 and 2005. Patients were grouped by AJCC stage and number of LNs recovered from the surgical specimen.

RESULTS

Of 1444 patients with primary SBA, 93 (6.4%), 529 (36.6%), 356 (24.7%), and 466 (32.3%) were initially diagnosed with stage I, II, III, and IV disease, respectively. Five-year overall survival (OS) rate was 59.8%, 39.5%, 27.0%, and 3.2% for patients with stage I, II, III, and IV SBA, respectively. When ≥10 nodes were recovered, OS rate increased nonsignificantly in stage I (73.2% vs. 55.6%) and significantly in stage II (61.8% vs. 32.9%, P < .001) but was unchanged in stage III (27.4% vs. 27.3%, P = .13). Recovery of ≥10 nodes occurred in 26.9%, 23.6%, and 42.1% of patients with stage I, II, and III SBA, respectively. Multivariate analysis identified age, AJCC stage, site of primary tumor, recovery of ≥10 LNs, and number of positive nodes as significant for OS.

CONCLUSIONS

We have found SBA staging is largely inadequate. Our results suggest recovery of ≥10 LNs ensures accurate staging. Improvement in stage II SBA OS after adequate LN may reflect a high degree of understaging in this dataset rather than a therapeutic effect of LAD.

摘要

背景

原发性小肠腺癌（SBA）是一种罕见的、对化疗耐药的肿瘤，具有侵袭性的临床特征。手术是主要的治疗方法，但为了优化空回肠 SBA 的治疗效果，需要切除多少淋巴结（LN）尚不清楚。

材料与方法

利用 SEER 数据库检索 1995 年至 2005 年间诊断为原发性空回肠 SBA 的患者。根据 AJCC 分期和手术标本中 LN 数量对患者进行分组。

结果

在 1444 例原发性 SBA 患者中，93 例（6.4%）、529 例（36.6%）、356 例（24.7%）和 466 例（32.3%）分别被诊断为 I 期、II 期、III 期和 IV 期疾病。I 期、II 期、III 期和 IV 期 SBA 患者的 5 年总生存率（OS）分别为 59.8%、39.5%、27.0%和 3.2%。当切除的淋巴结数≥10 枚时，I 期患者的 OS 率无显著提高（73.2% vs. 55.6%），而 II 期患者的 OS 率显著提高（61.8% vs. 32.9%，P<0.001），但 III 期患者的 OS 率无显著变化（27.4% vs. 27.3%，P=0.13）。I 期、II 期和 III 期 SBA 患者中，分别有 26.9%、23.6%和 42.1%的患者切除的淋巴结数≥10 枚。多变量分析确定年龄、AJCC 分期、原发肿瘤部位、切除的淋巴结数≥10 枚和阳性淋巴结数与 OS 相关。