Prognostic Clinicopathological Factors After Curative Resection of Small Bowel Adenocarcinoma

Inoué, Yoshihiro; Hayashi, Michihiro; Satou, Nayuko; Miyamoto, Yoshiharu; Hirokawa, Fumitoshi; Asakuma, Mitsuhiro; Shimizu, Tetsunosuke; Kayano, Hajime; Yamamoto, Masashi; Yamana, Hidenori; Okuda, Jun; Egashira, Yasuyuki; Tanigawa, Nobuhiko

doi:10.1007/s12029-011-9290-0

Cited by 9 publications

(3 citation statements)

References 12 publications

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“…Tumor grade has been reported to be the single most important prognostic factor in small bowel adenocarcinomas [ 22 ]. Meanwhile, other independent factors, such as age, tumor size, and M stage, were also significant risk factors for poorer survival [ 3 , 14 ]. After uni- and multi-variate Cox analysis of clinical characteristics for prognosis of SBA, we found that age, T stage, M stage, grade, number of metastatic LNs, and tumor size were associated with prognosis in these 2 cohorts.…”

Section: Discussionmentioning

confidence: 99%

A New Metastatic Lymph Node Classification-based Survival Predicting Model in Patients With Small Bowel Adenocarcinoma: A Derivation and Validation Study

Wu¹,

Chen²,

Zhang³

et al. 2018

EBioMedicine

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BackgroundCurrent methods of lymph node (LN) staging are controversial in predicting the survival of SBA. We aimed to develop an alternative LN-classification-based nomogram to individualize SBA prognosis.MethodsBased on the data from the Surveillance, Epidemiology, and End Results (SEER) database of patients diagnosed with SBA between 2004 and 2014, we identified the cut-off points for the number of LNs examined and the number found to be metastatic using the K-adaptive partitioning (KAPS) algorithm. Using metastatic LNs, a nomogram predicting the survival of SBA was derived, internally and externally validated, and measured by calibration curve, C-index, and decision curve analysis (DCA), and compared to the 8th TNM stage.ResultsA total of 1516 patients were included. The cut-off of 17 was the optimal examined LN number. For metastatic LN numbers, the cut-off points were 0, 2, and 8. The C-index for the nomogram was higher than the 8th TNM staging (internal: 0.734; 95% CI, 0.693 to 0.775 vs. 0.677; 95% CI, 0.652 to 0.702, P < 0.001; external: 0.715; 95% CI, 0.674 to 0.756 vs. 0.648; 95% CI, 0.602 to 0.693, P < 0.001). Also, the nomogram showed good calibration in internal and external validation and larger net benefit than TNM staging.ConclusionWe modified current N staging into a 4-level staging system based on the number of metastatic LNs: N0, no LN metastasis; N1, 1–2 metastatic LNs; N2, 3–8 metastatic LNs, and N3, >8 metastatic LNs and set the least examined LN number to 17. A nomogram based on this staging showed great clinical usability than TNM staging for predicting the survival of SBA patients.

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Section: Discussionmentioning

confidence: 99%

A New Metastatic Lymph Node Classification-based Survival Predicting Model in Patients With Small Bowel Adenocarcinoma: A Derivation and Validation Study

Wu¹,

Chen²,

Zhang³

et al. 2018

EBioMedicine

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“…Given the paucity of prospective data in the management of small intestine cancer, the treatment of small intestine adenocarcinoma has been extrapolated from colon cancer in clinical practice. Most published studies of small intestine adenocarcinoma are retrospective, either from single institutions with an underlying selection bias or having used large registry or administrative datasets, which lacked information on some important clinical variables such as performance status [ 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 ]. The current study aims to determine the outcomes of patients with small intestine adenocarcinoma who were diagnosed in a Canadian province over a decade.…”

Section: Introductionmentioning

confidence: 99%

Outcomes of Patients with Small Intestine Adenocarcinoma in a Canadian Province: A Retrospective Multi-Center Population-Based Cohort Study

Yanko

Mahmood

et al. 2022

Cancers

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Background: Small intestine adenocarcinoma is a rare cancer. The current study aims to determine the outcomes of patients with small intestine adenocarcinoma in a Canadian province. Methods: This retrospective population-based cohort study assessed patients with small intestine adenocarcinoma who were diagnosed from 2008 to 2017 in Saskatchewan. A Cox proportional multivariate regression analysis was performed to determine the correlation between survival and exploratory factors. Results: 112 eligible patients with a median age of 73 years and M:F of 47:53 were identified. Overall, 75% had a comorbid illness, and 45% had a WHO performance status >1. Of the 112 patients, 51 (46%) had early-stage disease and 61 (54%) had advanced-stage disease. The median overall survival (mOS) was as follows: stage one, 59 months; stage two, 30 months; stage three, 20 months; and stage four, 3 months (p < 0.001). The median disease-free survival of patients with stage three disease who received adjuvant chemotherapy was 26 months (95% CI:23.1–28.9) vs. 4 months (0.0–9.1) with observation (p = 0.04). Patients who received chemotherapy for advanced disease had a mOS of 10 months (3.5–16.5) vs. 2 months (0.45–3.6) without chemotherapy (p < 0.001). In the multivariate analysis, stage four disease, hazard ratio (HR), 3.20 (1.84–5.40); WHO performance status >1, HR, 2.22 (1.42–3.45); lack of surgery, HR, 2.10 (1.25–3.50); and a neutrophil:lymphocyte ratio of >4.5, HR, 1.72 (1.10–2.71) were significantly correlated with inferior survival. Conclusions: Most patients with small intestine adenocarcinoma were diagnosed with advanced-stage disease. Advanced-stage disease, poor performance status, lack of surgery and a baseline neutrophil:lymphocyte ratio >4.5 were correlated with inferior survival.

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“… 12 (p218) , 13 (p5) , 14 Other studies have also shown that age, tumor location, tumor size, and high CEA levels in the blood may be related to prognosis. 15 , 16 Peripheral blood cell counts are associated with the survival of patients with malignant solid tumors, such as colon and gastric cancers, 17 , 18 (p342) but there is insufficient information on SBA.…”

Section: Introductionmentioning

confidence: 99%

Risk and Prognostic Factors for Small Bowel Adenocarcinoma: A Multicenter Retrospective Observational Study in China

Wei

Chen

et al. 2022

Clin Med Insights Oncol

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Background: 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. Methods: 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. Results: 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. Conclusion: We found different independent prognostic factors for tumors at different locations. This finding warrants further investigation to ensure more effective management strategies for SBA.

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Prognostic Clinicopathological Factors After Curative Resection of Small Bowel Adenocarcinoma

Abstract: In small bowel adenocarcinoma, location, size, and TNM stage of the tumors were the independent prognostic factors after curative resections. Partial resection with mural lymphadenectomy may be recommended as optimal surgery for small bowel adenocarcinoma.

Cited by 9 publications

References 12 publications

A New Metastatic Lymph Node Classification-based Survival Predicting Model in Patients With Small Bowel Adenocarcinoma: A Derivation and Validation Study

A New Metastatic Lymph Node Classification-based Survival Predicting Model in Patients With Small Bowel Adenocarcinoma: A Derivation and Validation Study

Outcomes of Patients with Small Intestine Adenocarcinoma in a Canadian Province: A Retrospective Multi-Center Population-Based Cohort Study

Risk and Prognostic Factors for Small Bowel Adenocarcinoma: A Multicenter Retrospective Observational Study in China

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