Department of Digestive Oncology, European Georges Pompidou Hospital, Assistance Publique-Hôpitaux de Paris (APHP), Université Paris Cité, Paris Cancer Institute CARPEM, Paris, France.
Methodology and Quality of Life Unit in Oncology, centre hospitalier universitaire (CHU) Besançon, Hôpital Jean Minjoz, Besançon, France.
JNCI Cancer Spectr. 2023 Aug 31;7(5). doi: 10.1093/jncics/pkad064.
Small bowel adenocarcinoma is a rare cancer, and the role of adjuvant chemotherapy for localized disease is still debated.
This retrospective multicenter study included all consecutive patients who underwent curative surgical resection for localized small bowel adenocarcinoma between 1996 and 2019 from 3 French cohort studies. Prognostic and predictive factors of adjuvant chemotherapy efficacy were analyzed for disease-free survival and overall survival. The inverse probability of treatment weighting method was applied in the Cox regression model using the propensity score derived from multivariable logistic regression.
A total of 354 patients were included: median age, 63.5 years; duodenum location, 53.5%; and tumor stage I, II, and III in 31 (8.7%), 144 (40.7%), and 179 (50.6%) patients, respectively. The adjuvant chemotherapy was administered in 0 (0%), 66 (48.5%), and 143 (80.3%) patients with stage I, II, and III, respectively (P < .0001). In the subgroup analysis by inverse probability of treatment weighting method, a statistically significant disease-free survival and overall survival benefit in favor of adjuvant chemotherapy was observed in high-risk stage II (T4 and/or <8 lymph nodes examined) and III (T4 and/or N2) but not for low-risk stage II (T3 and ≥8 lymph nodes examined) and III (T1-3/N1) tumors (Pinteraction < .05). Furthermore, tumor location in jejunum and ileum was also a statistically significant predictive factor of response to adjuvant chemotherapy in stage II and III tumors (Pinteraction < .05).
In localized small bowel adenocarcinoma, adjuvant chemotherapy seems to provide a statistically significant survival benefit for high-risk stage II and III tumors and for jejunum and ileum tumor locations.
小肠腺癌是一种罕见的癌症，辅助化疗对局限性疾病的作用仍存在争议。
本回顾性多中心研究纳入了 1996 年至 2019 年期间，来自法国的 3 个队列研究中，经手术切除治疗的局限性小肠腺癌患者。分析了无病生存和总生存的辅助化疗疗效的预后和预测因素。使用多变量逻辑回归得出的倾向评分，在 Cox 回归模型中应用逆概率治疗加权法。
共纳入 354 例患者：中位年龄为 63.5 岁；十二指肠部位占 53.5%；肿瘤分期 I、II 和 III 期分别为 31 例（8.7%）、144 例（40.7%）和 179 例（50.6%）。I、II 和 III 期患者中，分别有 0 例（0%）、66 例（48.5%）和 143 例（80.3%）接受了辅助化疗（P<0.0001）。在逆概率治疗加权法的亚组分析中，观察到高风险 II 期（T4 和/或<8 个淋巴结检查）和 III 期（T4 和/或 N2）以及 III 期（T1-3/N1）肿瘤中，辅助化疗在无病生存和总生存方面有显著获益，但在低风险 II 期（T3 和≥8 个淋巴结检查）和 III 期肿瘤中没有获益（P 交互<.05）。此外，II 期和 III 期肿瘤的空肠和回肠部位也是辅助化疗疗效的显著预测因素（P 交互<.05）。
在局限性小肠腺癌中，辅助化疗似乎为高危 II 期和 III 期肿瘤以及空肠和回肠肿瘤部位提供了显著的生存获益。
