Legué Laura M, Bernards Nienke, Gerritse Sophie L, van Oudheusden Thijs R, de Hingh Ignace H J T, Creemers Geert-Jan M, Ten Tije Albert J, Lemmens Valery E P P
a Department of Internal Medicine, Medical Oncology , Catharina Hospital , Eindhoven , The Netherlands.
b The Netherlands Cancer Registry , Comprehensive Cancer Organisation the Netherlands , Utrecht , The Netherlands.
Acta Oncol. 2016 Sep-Oct;55(9-10):1183-1189. doi: 10.1080/0284186X.2016.1182211. Epub 2016 May 12.
We conducted a population-based study to establish the incidence, treatment and overall survival over time of patients with small bowel adenocarcinoma.
All patients diagnosed with small bowel adenocarcinoma in the Netherlands between 1999 and 2013 were included (n = 1775). Age-standardized incidence rates were calculated per 100 000 person-years using the European standardized population rate. The influence of patient and tumor characteristics on the administration of chemotherapy was analyzed by means of a multivariable logistic regression analysis. The Cochran-Armitage trend test was conducted to evaluate trends in treatment and survival and the Cox proportional hazards model was used to identify prognostic factors of overall survival.
The incidence of small bowel adenocarcinomas increased, mainly due to an almost twofold increase of duodenal adenocarcinomas. Patients with locoregional duodenal tumors were less likely to undergo surgery (58%), towards 95% of the locoregional jejunal and ileal tumors (p < 0.0001). The use of chemotherapy doubled for adjuvant (7-15%) and palliative chemotherapy (19-37%). Median overall survival of patients with locoregional disease increased from 19 to 34 months (p = 0.0006), whereas median overall survival of patients with metastatic disease remained 4-5 months. Favorable prognostic factors for prolonged survival in locoregional disease, identified by multivariable survival analysis, included age <60 years, tumor stage I or II, diagnosis in 2009-2013, surgical treatment and chemotherapy. Favorable prognostic factors for prolonged survival in metastatic disease were age <50 years, jejunal tumors, surgical treatment and chemotherapy.
Small bowel adenocarcinomas are rare tumors with an increasing incidence. The administration of adjuvant and palliative chemotherapy doubled, but median overall survival only increased for patients with locoregional disease. Given the rarity and dismal prognosis, it is important to develop international studies to determine the optimal treatment for these patients.
我们开展了一项基于人群的研究，以确定小肠腺癌患者的发病率、治疗情况及随时间变化的总生存率。
纳入1999年至2013年间在荷兰诊断为小肠腺癌的所有患者（n = 1775）。使用欧洲标准化人口率计算每10万人年的年龄标准化发病率。通过多变量逻辑回归分析来分析患者和肿瘤特征对化疗应用的影响。采用 Cochr an-Armitage趋势检验来评估治疗和生存趋势，并使用Cox比例风险模型来确定总生存的预后因素。
小肠腺癌的发病率有所上升，主要是由于十二指肠腺癌几乎增加了两倍。局部十二指肠肿瘤患者接受手术的可能性较小（58%），而局部空肠和回肠肿瘤患者的这一比例接近95%（p < 0.0001）。辅助化疗（7% - 15%）和姑息化疗（19% - 37%）的使用增加了一倍。局部疾病患者的中位总生存期从19个月增加到34个月（p = 0.0006），而转移性疾病患者的中位总生存期仍为4 - 5个月。多变量生存分析确定的局部疾病患者延长生存期的有利预后因素包括年龄<60岁、肿瘤分期为I或II期、2009 - 2013年诊断、手术治疗和化疗。转移性疾病患者延长生存期的有利预后因素包括年龄<50岁、空肠肿瘤、手术治疗和化疗。
小肠腺癌是发病率不断上升的罕见肿瘤。辅助化疗和姑息化疗的应用增加了一倍，但仅局部疾病患者的中位总生存期有所增加。鉴于其罕见性和预后不佳，开展国际研究以确定这些患者的最佳治疗方法很重要。
