Li Xiaoyuan, Ying Hongyan, Cheng Yuejuan, Zhao Lin, Zhao Sun, Bai Chunmei, Zhou Jianfeng
Department of Medical Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China.
J BUON. 2019 Nov-Dec;24(6):2539-2545.
Small bowel adenocarcinoma (SBA) is an uncommon malignancy with poor prognosis and therefore difficult to study. The purpose of this study was to evaluate the characteristics, treatments and prognostic factors in patients with metastatic or locally unresectable SBA.
Epidemiological and treatment data from metastatic or locally unresectable SBA patients who were admitted to Peking Union Medical College Hospital for first-line chemotherapy between December 2003 and November 2016 were retrospectively analyzed.
Of the 34 enrolled patients, 22 (64.7%) were male and 12 (35.3%) female, with a median age of 52 years. Tumors originated in the duodenum in 24 (70.6%) patients. All patients received one of the following regimens as first-line therapy: FOLFOX or XELOX (n = 27), FOLFIRI or CAPIRI (n = 5), GEMOX (n = 1), and TP (n = 1). The response rate and disease control rate were 11.8 and 61.8%, respectively. The median progression-free survival (PFS) and overall survival (OS) were 4.5 and 13.8 months, respectively. Multivariate analysis revealed that liver metastasis was independently associated with poor PFS, and both unresected primary tumor and males were significantly associated with poor OS. The survival of three metastatic patients was 52-96 months after combination treatment of chemotherapy, resection of primary tumor and metastasis.
The prognosis of metastatic or locally unresectable SBA was poor, and unresected primary tumor and males were significantly associated with poor OS. Combined modality therapy of systemic chemotherapy combined with local treatment of the primary tumor and oligometastasis might improve prognosis in selected patients.
小肠腺癌（SBA）是一种罕见的恶性肿瘤，预后较差，因此难以进行研究。本研究的目的是评估转移性或局部不可切除SBA患者的特征、治疗方法和预后因素。
回顾性分析2003年12月至2016年11月期间在北京协和医院接受一线化疗的转移性或局部不可切除SBA患者的流行病学和治疗数据。
34例入组患者中，男性22例（64.7%），女性12例（35.3%），中位年龄52岁。24例（70.6%）患者肿瘤起源于十二指肠。所有患者接受以下方案之一作为一线治疗：FOLFOX或XELOX（n = 27）、FOLFIRI或CAPIRI（n = 5）、GEMOX（n = 1）和TP（n = 1）。缓解率和疾病控制率分别为11.8%和61.8%。中位无进展生存期（PFS）和总生存期（OS）分别为4.5个月和13.8个月。多因素分析显示，肝转移与PFS差独立相关，未切除的原发肿瘤和男性均与OS差显著相关。3例转移患者在化疗、原发肿瘤和转移灶切除联合治疗后的生存期为52 - 96个月。
转移性或局部不可切除SBA的预后较差，未切除的原发肿瘤和男性与OS差显著相关。全身化疗联合原发肿瘤和寡转移灶局部治疗的综合治疗模式可能改善部分患者的预后。
