Wei Xin, Chen Ke, Li Dong-Chang, Li He, Zhu Liang, Wang Zheng-Guang
The General Surgery Department, The First Affiliated Hospital of Anhui Medical University, Hefei, China.
The Emergency Surgery, The Second Affiliated Hospital of Anhui Medical University, Hefei, China.
Clin Med Insights Oncol. 2022 Apr 24;16:11795549221091207. doi: 10.1177/11795549221091207. eCollection 2022.
Small bowel adenocarcinoma (SBA) is a rare malignancy that accounts for 3% of all gastrointestinal tumors. We evaluated the clinical characteristics, outcomes, and prognostic factors of primary SBAs.
We retrospectively analyzed the clinicopathological features and clinical outcomes of 300 patients with SBA from three institutions in China between January 2003 and July 2020. Overall survival (OS) was analyzed using the Kaplan-Meier method and it was statistically compared using the log-rank test. Single-variable and multivariate analyses were used to identify the significant correlates of OS.
The primary tumor was on the duodenal papilla in 156 patients (52%), in the duodenum in 60 patients (20%), and in the jejunum-ileum in 84 patients (28%). The median OS of the entire cohort was 32.5 months (range, 0-213 months), with a 1-year OS rate of 78.0%. For jejunoileal adenocarcinoma, advanced age, advanced T stage, advanced N stage, more positive lymph nodes, distant metastasis, high carcinoembryonic antigen (CEA), and lymphocyte-to-monocyte ratio < 2.32 predicted worse survival on single-variable analysis. Multivariate analysis showed that advanced age, advanced tumor node metastases (TNM) stage, high CEA level, high alpha fetoprotein (AFP) level, and low prealbumin level were independent prognostic factors for non-ampullary SBA. The independent prognostic factors for duodenal papilla adenocarcinoma included TNM Stage III, nerve invasion, low platelet/lymphocyte ratio, and high CA19-9.
We found different independent prognostic factors for tumors at different locations. This finding warrants further investigation to ensure more effective management strategies for SBA.
小肠腺癌（SBA）是一种罕见的恶性肿瘤，占所有胃肠道肿瘤的3%。我们评估了原发性SBA的临床特征、预后及预后因素。
我们回顾性分析了2003年1月至2020年7月期间来自中国三个机构的300例SBA患者的临床病理特征和临床结局。采用Kaplan-Meier法分析总生存期（OS），并使用对数秩检验进行统计学比较。采用单变量和多变量分析确定OS的显著相关因素。
156例（52%）患者的原发性肿瘤位于十二指肠乳头，60例（20%）位于十二指肠，84例（28%）位于空肠-回肠。整个队列的中位OS为32.5个月（范围0 - 213个月），1年OS率为78.0%。对于空肠回肠腺癌，单变量分析显示高龄、T分期晚、N分期晚、更多阳性淋巴结、远处转移、高癌胚抗原（CEA）及淋巴细胞与单核细胞比值<2.32提示预后较差。多变量分析显示，高龄、晚期肿瘤淋巴结转移（TNM）分期、高CEA水平、高甲胎蛋白（AFP）水平及低前白蛋白水平是非壶腹SBA的独立预后因素。十二指肠乳头腺癌的独立预后因素包括TNM III期、神经侵犯、低血小板/淋巴细胞比值及高CA19-9。
我们发现不同部位肿瘤有不同的独立预后因素。这一发现值得进一步研究，以确保对SBA采取更有效的管理策略。
