Frequency, prognosis and treatment modalities of newly diagnosed small bowel cancer with liver metastases

Abstract

Background Population-based analysis for the liver metastases of small bowel cancer is currently lacking. This study aimed to analyze the frequency, prognosis and treatment modalities for newly diagnosed small bowel cancer patients with liver metastases. Methods Patients with small bowel cancer diagnosed from 2010 to 2015 were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. Binary logistic regression analysis was performed to determine predictors for the presence of liver metastases at diagnosis. Kaplan–Meier method and Cox regression analyses were performed for survival analyses. Results A total of 1461 small bowel cancer patients with liver metastases at initial diagnosis were identified, representing 16.5% of the entire set and 63.9% of the subset with metastatic disease to any distant site. Primary tumor with poorer histological type, larger tumor size, later N staging, more extrahepatic metastatic sites, and tumor on lower part of small intestine had increased propensity of developing liver metastases. The combined diagnostic model exhibited acceptable diagnostic efficiency with AUC value equal to 0.749. Patients with liver metastases had significant poorer survival (P < 0.001) than those without liver metastases. In addition, combination of surgery and chemotherapy (HR = 0.27, P < 0.001) conferred the optimal survival for patients with adenocarcinoma, while the optimal treatment options for NEC and GIST seemed to be surgery alone (HR = 0.24, P < 0.001) and chemotherapy alone (HR = 0.08, P = 0.022), respectively. Conclusions The combined predictor had a good ability to predict the presence of liver metastases. In addition, those patients with different histologic types should be treated with distinct therapeutic strategy for obtaining optimal survival.

Evaluation of Systemic Treatments of Small Intestinal Adenocarcinomas

“…After full-text revision, 57 studies were included, with a total of 35 176 patients. Among the 57 studies, 6 studies 27 , 28 , 29 , 30 , 31 , 32 were prospective cohort studies or phase 2 trials, and 51 studies 1 , 3 , 4 , 17 , 19 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 were retrospective in nature ( Table ; eTables 1 and 2 in…”

“…Of 57 studies, 23 studies 3 , 17 , 27 , 29 , 30 , 31 , 32 , 33 , 36 , 38 , 44 , 49 , 50 , 51 , 58 , 60 , 62 , 63 , 70 , 71 , 73 , 74 , 77 (40.4%) were subject to serious risk of bias due to the lack of multivariable analyses and selection bias (eTable 3 in Supplement 1 ). Thirty-three studies 1 , 4 , 19 , 28 , 34 , 35 , 37 , 39 , 40 , 41 , 42 , 43 , 45 , 46 , 47 , 48 , 52 , 53 , 54 , 55 , 56 , 57 , 59 , 61 , 64 , 65 , 66 , 67 , 69 , 72 , 75 , 76 , 78 (57.9%) had medium or low risk of bias.…”

“…Among the 57 studies, 6 studies were prospective cohort studies or phase 2 trials, and 51 studies were retrospective in nature (Table; eTables 1 and 2 in Supplement 1). Thirty studies assessed survival after adjuvant chemotherapy, and 40 studies described benefit of palliative chemotherapeutics. Thirteen studies were included in both groups.…”

“…Of 57 studies, 23 studies (40.4%) were subject to serious risk of bias due to the lack of multivariable analyses and selection bias (eTable 3 in Supplement 1). Thirty-three studies (57.9%) had medium or low risk of bias.…”

“…Our meta-analysis is affected by several limitations. Unfortunately, most studies 1 , 3 , 4 , 17 , 19 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 were nonrandomized cohort studies. Hence, the outcomes of some of our meta-analyses are subject to selection bias and confounding by prognostic factors.…”