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

Abstract

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.

Characteristics and outcomes of small bowel adenocarcinoma: 14 years of experience at a single tertiary hospital in Saudi Arabia

“…However, the median age in the present cohort was 53 years, which is relatively younger than the worldwide median age at diagnosis for SBA, perhaps due to the younger age distribution in the local population. In contrast to the young age at diagnosis in the present cohort (50% were younger than 55 years), other studies have found SBA to primarily be a disease of the elderly ( 3 , 12 , 13 , 21 ). SBA tends to occur more frequently in males ( 6 , 7 , 9 , 10 , 22 ), consistent with the present cohort.…”

“…SBA tends to occur more frequently in males ( 6 , 7 , 9 , 10 , 22 ), consistent with the present cohort. However, certain studies reported a relatively equal distribution by sex ( 12 , 13 , 21 ). There was no association between sex and survival outcomes in the present cohort; however, male sex was previously reported to be associated with worse survival outcomes in SBA ( 3 , 23 ).…”

“…The NLR has been proven to have prognostic survival value in a variety of solid tumors, including gastrointestinal malignancies ( 31 , 32 ). Recently, two studies indicated that a high NLR is associated with poor survival outcomes in patients with SBA ( 13 , 33 ). Yanko et al ( 13 ) used 4.5 as the optimal cutoff for the NLR.…”

“…Recently, two studies indicated that a high NLR is associated with poor survival outcomes in patients with SBA ( 13 , 33 ). Yanko et al ( 13 ) used 4.5 as the optimal cutoff for the NLR. They selected 4.5 based on the high median NLR in their cohort and the optimal NLR cutoff (median 3.5-4.5) of a previous study ( 34 ).…”

“…The factors associated with short overall survival (OS) are advanced stage, lack of surgery, older age, primary duodenal site and high baseline neutrophil-lymphocyte ratio (NLR) (11)(12)(13).…”