Wilhelm Alexander, Galata Christian, Beutner Ulrich, Schmied Bruno M, Warschkow Rene, Steffen Thomas, Brunner Walter, Post Stefan, Marti Lukas
Department of Surgery, St. Claraspital Basel, Basel, Switzerland.
Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.
J Surg Oncol. 2018 Mar;117(3):397-408. doi: 10.1002/jso.24877. Epub 2017 Oct 16.
This study assessed the influence of tumor localization of small bowel adenocarcinoma on survival after surgical resection.
Patients with resected small bowel adenocarcinoma, ACJJ stage I-III, were identified from the Surveillance, Epidemiology, and End Results database from 2004 to 2013. The impact of tumor localization on overall and cancer-specific survival was assessed using Cox proportional hazard regression models with and without risk-adjustment and propensity score methods.
Adenocarcinoma was localized to the duodenum in 549 of 1025 patients (53.6%). There was no time trend for duodenal localization (P = 0.514). The 5-year cancer-specific survival rate was 48.2% (95%CI: 43.3-53.7%) for patients with duodenal carcinoma and 66.6% (95%CI: 61.6-72.1%) for patients with cancer located in the jejunum or ileum. Duodenal localization was associated with worse overall and cancer-specific survival in univariable (HR = 1.73; HR = 1.81, respectively; both P < 0.001), multivariable (HR = 1.52; HR = 1.65; both P < 0.001), and propensity score-adjusted analyses (HR = 1.33, P = 0.012; HR = 1.50, P = 0.002). Furthermore, young age, retrieval of more than 12 regional lymph nodes, less advanced stage, and married matrimonial status were positive, independent prognostic factors.
Duodenal localization is an independent risk factor for poor survival after resection of adenocarcinoma.
本研究评估了小肠腺癌的肿瘤定位对手术切除后生存情况的影响。
从2004年至2013年的监测、流行病学和最终结果数据库中识别出ACJJ分期为I - III期的小肠腺癌切除患者。使用Cox比例风险回归模型，采用有风险调整和倾向评分方法，评估肿瘤定位对总生存和癌症特异性生存的影响。
1025例患者中有549例（53.6%）腺癌位于十二指肠。十二指肠定位不存在时间趋势（P = 0.514）。十二指肠癌患者的5年癌症特异性生存率为48.2%（95%CI：43.3 - 53.7%），空肠或回肠癌患者为66.6%（95%CI：61.6 - 72.1%）。在单变量分析（HR分别为1.73和1.81；P均<0.001）、多变量分析（HR分别为1.52和1.65；P均<0.001）以及倾向评分调整分析中（HR = 1.33，P = 0.012；HR = 1.50，P = 0.002），十二指肠定位与较差的总生存和癌症特异性生存相关。此外，年轻、区域淋巴结清扫超过12枚、分期较晚以及已婚是积极的独立预后因素。
十二指肠定位是腺癌切除术后生存不良的独立危险因素。
