Prognostic Factors of Primary Small Bowel Adenocarcinoma: Univariate and Multivariate Analysis

Wu, Ting-Jung; Yeh, Chun‐Nan; Chao, Tzu‐Chieh; Jan, Yi-Yin; Chen, Miin-Fu

doi:10.1007/s00268-005-7898-6

Cited by 75 publications

(49 citation statements)

References 35 publications

(80 reference statements)

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“…In agreement with previous findings [5,7,13,14,19], we found that relapse occurred at distant sites (100%) but not at locoregional sites (0%). Despite our finding that systemic adjuvant therapy did not enhance RFS or OS, the failure patterns we observed strongly support further investigations of systemic adjuvant therapy.…”

Section: Discussionsupporting

confidence: 82%

“…The factors associated with a poor prognosis in patients with SBA are duodenal location [11,12,13], poor differentiation [11,12], non-curative resection or positive margins [5,7,12,14,15], T 4 tumor stage [5,12], TNM stage [11,13,16], and lymph node involvement [12,14,15,17]. Among our patients, poor differentiation and lymph node involvement were statistically significant indicators of a poor prognosis in univariate analysis, with lymph node involvement being the sole prognostic factor in multivariate analysis.…”

Section: Discussionmentioning

confidence: 99%

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Adjuvant Chemotherapy for Small Bowel Adenocarcinoma after Curative Surgery

Koo¹,

Yun

Hong³

et al. 2011

Oncology

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Objectives: We evaluated prognostic factors affecting relapse-free survival (RFS) and overall survival (OS), and investigated the role of adjuvant chemotherapy in patients with small bowel adenocarcinoma (SBA). Methods: Data from 52 patients with SBA who underwent curative surgery at the Asan Medical Center between January 1989 and December 2009 were retrospectively analyzed. Patients were divided into two groups: those who did (n = 23) and did not (n = 29) receive adjuvant chemotherapy. Results: At a median follow-up of 32.2 months (range, 5.5–212.2 months), relapses had occurred in 17 patients (32.7%), with a 5-year RFS rate of 52.9% (95% CI, 39.3–66.5%), and 19 patients (36.5%) had died, with a 5-year OS rate of 59.0% (95% CI, 45.6–72.4%). The most frequent sites of relapse were the peritoneum and liver. Multivariate analysis showed that lymph node involvement was the only factor independently associated with poor RFS and OS. After inverse probability of treatment weighting adjustment, adjuvant chemotherapy did not enhance RFS [hazard ratio (HR), 1.399; 95% CI, 0.498–3.933] or OS (HR 0.797; 95% CI, 0.307–2.068). Conclusions: Lymph node involvement is a predictor of poor prognosis in patients with SBA who undergo curative surgery.

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Section: Discussionsupporting

confidence: 82%

Section: Discussionmentioning

confidence: 99%

Adjuvant Chemotherapy for Small Bowel Adenocarcinoma after Curative Surgery

Koo¹,

Yun

Hong³

et al. 2011

Oncology

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“…The median number of TLNs assessed (interquartile range [IQR]) according to disease stage was 1 (IQR, 0-7) for stage I, 4 (IQR, 0-9) for stage II, and 8 (IQR, 4-13) for stage III. In patients with stage II cancer who had at least 1 lymph node assessed, the median number of TLNs assessed (IQR) was 6 (IQR, [3][4][5][6][7][8][9][10][11][12]. The median number of TLNs accessed (IQR) in patients with stage II disease was lower in patients with duodenal cancers (median, 3; IQR, 0-9) than in patients with jejunal cancers (median, 5; IQR, 2-10; P ¼ .01) and patients with ileal cancers (median, 5; IQR, 2-12; P < .01).…”

Section: Clinicopathologic Characteristicsmentioning

confidence: 99%

“…17 Several other small, single-institution studies have not reported a difference in survival dependent on a subsite within the small bowel. 9,30,31 Whether a difference in outcome reflects a biologic distinction between tumors of the duodenum compared with tumors of the jejunum and ileum is not known. In the current analysis, after adjusting for covariates, the duodenal site was a poor prognostic factor.…”

Section: Lymph Nodes In Small Bowel Carcinoma/overman Et Almentioning

confidence: 99%

Prognostic value of lymph node evaluation in small bowel adenocarcinoma

Overman

Wolff

et al. 2010

Cancer

104

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BACKGROUND:The presence of distant metastases and the completeness of resection are important prognostic factors in patients with small bowel adenocarcinoma (SBA); however, the influence of lymph node metastasis on patient outcome has not been well characterized. The objective of the current study was to evaluate the impact of the number of positive and negative lymph nodes on survival after curative resection. METHODS: Patients who had SBA diagnosed between 1988 and 2005 were identified from the Surveillance, Epidemiology, and End Results (SEER) registry. Cox proportional hazards regression analyses were performed after adjusting for age, sex, race, tumor stage, tumor grade, and primary site. Five-year disease-specific survival (DSS) was determined, all patients were categorized according to the total lymph nodes (TLNs) assessed, and patients with stage III disease also were categorized according to the number of positive lymph nodes (PLNs) and the PLN-to-TLN ratio (the lymph node ratio [LNR]). RESULTS: In total, 1991 patients (n ¼ 1216 with stage I/II SBA and n ¼ 775 with stage III SBA) were analyzed. Survival depended on the TLNs assessed. The 5-year DSS rate for patients with stage II disease was associated with the TLNs assessed (44%, 69%, and 83% for 0 TLNs, 1-7 TLNs, and >7 TLNs, respectively). The 5-year DSS for patients with stage III disease was associated with the number of PLNs (58% and 37% for <3 PLNs and 3 PLNs, respectively). Among patients with stage III disease, the LNR was even more predictive of survival than stratification by the number of PLNs. CONCLUSIONS: Survival after surgical resection for stage I, II, and III SBA was associated with the TLNs assessed. Stratifying patients with stage III disease into those with <3 PLNs and 3 PLNs significantly improved prognostication. Cancer 2010;116:5374-82.

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“…Ähnlich wie in vorliegender Untersuchung, konnten auch andere Autoren durch multivariate Analyse ein fortgeschrittenes Tumorstadium neben der chirurgischen Entfernung des Karzinoms als unabhängige Prognosefaktoren sichern [14,28,30]. 5JÜR 5-Jahres-Überleben, n.a.…”

Section: Therapieunclassified