Department of Radiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China.
Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Cancer Med. 2020 Sep;9(18):6638-6645. doi: 10.1002/cam4.3266. Epub 2020 Aug 4.
The role of surgery and chemotherapy for stage IV small bowel adenocarcinoma (SBA) is still confused. The results from previous analyses have been limited by small sample sizes and different treatment regimens.
Patients with stage IV SBA were identified in the Surveillance, Epidemiology, and End Result Program (SEER) database. Cause-specific survival (CSS) and overall survival (OS) were calculated with Kaplan-Meier methods and log-rank test. Multiple logistic and Cox regression identified covariates associated with treatment options and survival.
1219 eligible patients were involved in this study. The median age was 67 (range, 20-95) with 655 (53.7%) males and 564 (46.3%) females. Age and primary tumor site were significantly associated with surgery performance, age was also significantly associated with chemotherapy (P < .01). To reduce bias, further six subgroups were divided by age (≤65 and >65) and primary tumor site (duodenum, jejunum and ileum). Chemotherapy and surgery conferred a benefit on survival of the whole cohort (the median CSS of different treatment groups were 17, 9, 4, and 1 month respectively, P < .001) and most subgroups (83.3%, 5/6). In multivariate analysis, surgery (P = .006), and chemotherapy (P = .038) are still independent factors of favorable CSS and OS. For patients with surgery (n = 362), radical surgery was not associated with better survival.
For stage IV SBA patients, the present study showed that age and primary tumor site were significantly associated with treatment preference. Surgery and chemotherapy were consistently correlated with favorable survival for the whole cohort or most specific subgroups. However, compared with palliative surgery, significant association was not found in patients with radical surgery with better outcome. More prospective well-defined cohorts would add knowledge for this rare disease.
手术和化疗在 IV 期小肠腺癌（SBA）中的作用仍存在争议。先前的分析结果受到样本量小和不同治疗方案的限制。
在监测、流行病学和最终结果（SEER）数据库中确定 IV 期 SBA 患者。采用 Kaplan-Meier 方法和对数秩检验计算特定原因生存率（CSS）和总生存率（OS）。多因素逻辑回归和 Cox 回归分析确定与治疗选择和生存相关的协变量。
本研究纳入了 1219 名符合条件的患者。中位年龄为 67 岁（范围 20-95 岁），男性 655 例（53.7%），女性 564 例（46.3%）。年龄和原发肿瘤部位与手术的实施显著相关，年龄也与化疗显著相关（P<0.01）。为了减少偏倚，进一步按年龄（≤65 岁和>65 岁）和原发肿瘤部位（十二指肠、空肠和回肠）将六个亚组进行了划分。化疗和手术均能提高整个队列的生存获益（不同治疗组的中位 CSS 分别为 17、9、4 和 1 个月，P<0.001）和大多数亚组（83.3%，5/6）。多变量分析显示，手术（P=0.006）和化疗（P=0.038）仍然是 CSS 和 OS 良好的独立因素。对于接受手术治疗的患者（n=362），根治性手术与生存改善无关。
对于 IV 期 SBA 患者，本研究表明年龄和原发肿瘤部位与治疗偏好显著相关。手术和化疗与整个队列或大多数特定亚组的良好生存相关。然而，与姑息性手术相比，根治性手术在预后较好的患者中未发现显著关联。更多前瞻性、明确的队列研究将为这一罕见疾病提供更多的知识。
