The characteristics and outcomes of small bowel adenocarcinoma: a multicentre retrospective observational study

Abstract

Background:Small bowel adenocarcinoma (SBA) is a rare malignancy that accounts for 1–2% of gastrointestinal tumours. We investigated the clinical characteristics, outcomes, and prognostic factors of primary SBA.Methods:We retrospectively analysed the characteristics and clinical courses of 205 SBA patients from 11 institutions in Japan between June 2002 and August 2013.Results:The primary tumour was in the duodenum and jejunum/ileum in 149 (72.7%) and 56 (27.3%) patients, respectively. Sixty-four patients (43.0%) with duodenal adenocarcinoma were asymptomatic and most cases were detected by oesophagogastroduodenoscopy (EGD), which was not specifically performed for the detection or surveillance of duodenal tumours. In contrast, 47 patients (83.9%) with jejunoileal carcinoma were symptomatic. The 3-year survival rate for stage 0/I, II, III, and IV cancers was 93.4%, 73.1%, 50.9%, and 15.1%, respectively. Multivariate analysis revealed performance status 3–4, high carcinoembryonic antigen, high lactate dehydrogenase (LDH), low albumin, symptomatic at diagnosis, and stage III/IV disease were independent factors for overall survival (OS). Ten patients (18.5%) with stage IV disease were treated with a combination of resection of primary tumour, local treatment of metastasis, and chemotherapy; this group had a median OS of 36.9 months.Conclusions:Although most SBA patients were diagnosed with symptomatic, advanced stage disease, some patients with duodenal carcinoma were detected in early stage by EGD. High LDH and symptomatic at diagnosis were identified as novel independent prognostic factors for OS. The prognosis of advanced SBA was poor, but combined modality therapy with local treatment of metastasis might prolong patient survival.

Efficacy of surgery and chemotherapy for stage IV small bowel adenocarcinoma: A population‐based analysis using Surveillance, Epidemiology, and End Result Program database

“…The 5‐year OS of patients with resectable liver metastasis CRC could reach to 58% 17 . For stage IV SBA patients without any treatment, the OS were extremely poor, ranging from 2 to 5.9 months 5,18,19 and the studies to explore the efficacy of surgery for stage IV SBA were scarce. 152 stage IV SBA patients with peritoneal metastases were enrolled in a restrospective study in 2018, prolonged survival have been archived using combined treatment strategy of cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy (median OS was 32 months with survival rates of 46.4% at 3 years).…”

Ovarian metastases from ileum cancer in a patient with germline EPCAM gene deletion successfully treated with surgical resection and CAPOX chemotherapy: a case report

“…Surgical resection is the most common option for localized tumors. In a retrospective study performed in Japan, median overall survival in 10 patients with stage IV small bowel cancer who underwent surgical resection or local radiotherapy plus chemotherapy was 36.9 months [15], suggesting that a multidisciplinary approach could improve prognosis even in patients with distant metastases. Although the present patient was diagnosed at an advanced stage, complete resection was possible because the lesions were limited to the small bowel and ovary.…”

The evolving management of small bowel adenocarcinoma

“…While in approximately half of the patients with duodenal adenocarcinoma are asymptomatic, the majority of patients with jejunoileal adenocarcinoma is symptomatic [13]. The symptoms are initially rather nonspecific: abdominal pain, nausea, vomiting, weight loss and gastrointestinal bleeding [10,11,13,17,29]. Bowel obstruction is mainly observed in cases of jejunal or ileal tumor [27].…”

“…In addition to stage, a number of additional factors have been associated with poor prognosis and include male gender, older age, impaired performance status, black ethnicity, symptomatic at diagnosis, duodenal location, low serum albumin, high CEA or CA 19.9, high lactate dehydrogenase, poor tumor differentiation and positive margins [6,13,27,38]. Approximately, 33-35% of the patients have poorly differentiated tumors, which is significantly higher than the 21% observed in colon cancer [11,26].…”

“…In the USA, the estimated age-standardized incidence rose from 0.57 per 100,000 in 1973 to 0.73 per 100,000 in 2004 [6] and in the Netherlands from 0.5 per 100,000 in 1999 to 0.7 per 100,000 in 2013 [9]. The duodenum is the most frequently involved segment, being involved in 46-82% of the cases, followed by the jejunum (11-31%) and ileum (7-21%) [10][11][12][13].…”