Guo Xiaochuan, Mao Zhiyuan, Su Dan, Jiang Zhaocai, Bai Li
Department of Oncology, PLA General Hospital, Beijing, 100853, People's Republic of China.
Med Oncol. 2014 Apr;31(4):913. doi: 10.1007/s12032-014-0913-8. Epub 2014 Mar 18.
The aim of the study was to describe and analyze the clinicopathological features and diagnosis of Chinese patients with small intestine primary malignant tumors and to explore the best therapy to small bowel adenocarcinoma (SBA). More than 26,000 patients with digestive tract malignant tumors received treatment in PLA hospital from 2000 to 2011, and among them, there were 887 patients who had small intestine primary malignant tumors, and 666 of 887 patients had the completed basic clinical documents. We retrospectively analyzed the correlation between clinical and pathological features of the 666 patients and analyzed the survival and prognosis of 173 SBA patients with follow-up data. Both the number of patients with primary malignant tumors of the small intestine and the number of patients who received chemotherapy showed an increasing trend. The ratio of male to female was 1.58:1. The male patients significantly exceed the female patients with tumors of non-ampullary duodenum, jejunum and duodenal ampulla; and most of the patients are over 60 years of age. For patients burdened with either of the pathological types of tumors, the males exceeded the females, but there was no significant difference. Abdominal pain was the main clinical manifestation for patients with tumors of non-ampullary duodenum, jejunum and ileum, and the most common clinical manifestations were jaundice and abdominal pain for patients with ampullary duodenal tumors, adenocarcinoma, neuroendocrine tumors and sarcoma. In addition, patients with stromal tumors were prone to gastrointestinal bleeding. Gastrointestinal endoscopy was the most common examinational procedure. Patients under 60 years of age were prone to surgery and chemotherapy after surgery, and patients over 60 years of age were prone to supportive treatment and chemotherapy without surgery. The medium overall survival of patients who received surgery without chemotherapy, chemotherapy after surgery, chemotherapy without surgery and supportive treatment were 40.0, 35.0, 9.0 and 7.5 months, respectively. For the 173 SBA patients with follow-up data, treatment, age and distant metastasis were important prognostic factors; 149 of 173 SBA patients received only surgery, and the depth of tumor invasion, lymph node metastasis and surgical approach were important prognostic factors. Adjuvant chemotherapy had not provided significant benefit to prolong OS in patients with adenocarcinoma. The incidence of small intestine primary malignant tumors is very low, and it is difficult to diagnose. The patients should be aggressively treated and regularly followed up with related clinical and pathological features. Currently, surgery is the most effective treatment, and the role of chemotherapy needs further large-scale clinical studies.
本研究旨在描述和分析中国小肠原发性恶性肿瘤患者的临床病理特征及诊断方法，并探索小肠腺癌（SBA）的最佳治疗方案。2000年至2011年期间，超过26000例消化道恶性肿瘤患者在解放军医院接受治疗，其中887例患有小肠原发性恶性肿瘤，887例患者中有666例拥有完整的基本临床资料。我们回顾性分析了这666例患者临床与病理特征之间的相关性，并分析了173例有随访数据的SBA患者的生存及预后情况。小肠原发性恶性肿瘤患者数量及接受化疗的患者数量均呈上升趋势。男女比例为1.58:1。非壶腹十二指肠、空肠及十二指肠壶腹肿瘤患者中男性显著多于女性；且大多数患者年龄超过60岁。对于患有这两种病理类型肿瘤之一的患者，男性多于女性，但无显著差异。腹痛是非壶腹十二指肠、空肠及回肠肿瘤患者的主要临床表现，而壶腹十二指肠肿瘤、腺癌、神经内分泌肿瘤及肉瘤患者最常见的临床表现是黄疸和腹痛。此外，间质瘤患者易发生消化道出血。胃肠内镜检查是最常见的检查方法。60岁以下患者倾向于手术及术后化疗，60岁以上患者倾向于支持治疗及非手术化疗。未接受化疗的手术患者、术后化疗患者、非手术化疗患者及支持治疗患者的中位总生存期分别为40.0、35.0、9.0和7.5个月。对于173例有随访数据的SBA患者，治疗、年龄及远处转移是重要的预后因素；173例SBA患者中有149例仅接受了手术，肿瘤浸润深度、淋巴结转移及手术方式是重要的预后因素。辅助化疗对腺癌患者延长总生存期未显示出显著益处。小肠原发性恶性肿瘤发病率很低，且难以诊断。应对患者积极治疗，并根据相关临床及病理特征进行定期随访。目前，手术是最有效的治疗方法，化疗的作用需要进一步的大规模临床研究。
