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Clinical Outcomes of Small Bowel Adenocarcinoma.

Abstract

BACKGROUND

Small bowel adenocarcinomas (SBAs) are rare tumors. Management of SBA is extrapolated from colorectal cancer treatments. Recent evidence suggests that the biology and molecular features of SBA differ from colorectal cancer. The aim of this study was to evaluate the management and outcome of SBA patients. PATIENTS AND METHODS: The National Cancer Data Base (NCDB) was queried for patients with SBA between 2004 and 2013 using ICD-O-3 histology code 8140/3 and topography codes C17.0, C17.1, C17.2, C17.8, and C17.9. Univariate and multivariate survival analyses were conducted to analyze the association between SBA location and overall survival (OS) stratified by stage. Treatment outcomes of surgery, radiation, and systemic therapy were compared.

RESULTS

A total of 7954 SBA patients were identified; duodenum (D) 4607 (57.9%), jejunum (J) 1241 (15.6%), ileum (I) 857 (10.8%), and unspecified 1249 (15.7%). A total of 53.6% patients were male, and 76.6% white. Median age was 66 years. D mostly presented as stage IV disease (37.6%), J as stage II (34.5%) and IV disease (33.8%), and I as stage II (32.2%) and III (30.3%) disease (P < .001). Grade distribution was similar among D, J, and I; the majority were moderately differentiated (40.8%-55.0%), followed by poorly differentiated (30.9%-35.8%) and well differentiated (6.0%-12.4%) (P < .001). D underwent surgery (50.2%) less often than J (90.8%) and I (94.5%) (P < .001). Adjuvant radiation was provided in 8.5% of D, 2.6% of J, and 2.1% of I (P < .001). Adjuvant chemotherapy was provided in 21.9% of D, 50.2% of J, and 42.0% of I (P < .001). The rate of adjuvant chemotherapy was the highest in patients with stage III SBA, and was as follows: D (43.4%), J (65.4%), and I (63.6%) (P < .001). In univariate and multivariate analyses of all patients, adjuvant chemotherapy was associated with improved OS in stage II-III SBA patients. J had the best 5-year OS rate (42.0%; 95% confidence interval, 38.8-45.1, P < .001), and D had the worst (23.0%; 95% confidence interval, 21.6-24.2, P < .001). In multivariate analysis stratified by stage, chemotherapy was associated with improved OS in patients with stage II-IV SBA.

CONCLUSION

Most SBA patients present with stage IV disease. D underwent surgery less often than J and I. Stage II and III D received adjuvant chemotherapy less often compared to stage II and III J and I. Adjuvant chemotherapy was associated with improved OS in patients with stage II-III disease. J had the best 5-year OS rate, and D had the worst.

Authors+Show Affiliations

Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA. Electronic address: mehmet.akce@emory.edu.Winship Research Informatics, Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA.Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA.Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA.Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA.Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA.Winship Research Informatics, Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA.Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31606297

Citation

Akce, Mehmet, et al. "Clinical Outcomes of Small Bowel Adenocarcinoma." Clinical Colorectal Cancer, 2019.
Akce M, Jiang R, Zakka K, et al. Clinical Outcomes of Small Bowel Adenocarcinoma. Clin Colorectal Cancer. 2019.
Akce, M., Jiang, R., Zakka, K., Wu, C., Alese, O. B., Shaib, W. L., ... El-Rayes, B. F. (2019). Clinical Outcomes of Small Bowel Adenocarcinoma. Clinical Colorectal Cancer, doi:10.1016/j.clcc.2019.08.002.
Akce M, et al. Clinical Outcomes of Small Bowel Adenocarcinoma. Clin Colorectal Cancer. 2019 Sep 4; PubMed PMID: 31606297.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Clinical Outcomes of Small Bowel Adenocarcinoma. AU - Akce,Mehmet, AU - Jiang,Renjian, AU - Zakka,Katerina, AU - Wu,Christina, AU - Alese,Olatunji B, AU - Shaib,Walid L, AU - Behera,Madhusmita, AU - El-Rayes,Bassel F, Y1 - 2019/09/04/ PY - 2019/06/05/received PY - 2019/07/09/revised PY - 2019/08/27/accepted PY - 2019/10/14/entrez PY - 2019/10/14/pubmed PY - 2019/10/14/medline KW - Chemotherapy KW - Duodenal adenocarcinoma KW - Ileum KW - Jejunum KW - Small bowel cancer JF - Clinical colorectal cancer JO - Clin Colorectal Cancer N2 - BACKGROUND: Small bowel adenocarcinomas (SBAs) are rare tumors. Management of SBA is extrapolated from colorectal cancer treatments. Recent evidence suggests that the biology and molecular features of SBA differ from colorectal cancer. The aim of this study was to evaluate the management and outcome of SBA patients. PATIENTS AND METHODS: The National Cancer Data Base (NCDB) was queried for patients with SBA between 2004 and 2013 using ICD-O-3 histology code 8140/3 and topography codes C17.0, C17.1, C17.2, C17.8, and C17.9. Univariate and multivariate survival analyses were conducted to analyze the association between SBA location and overall survival (OS) stratified by stage. Treatment outcomes of surgery, radiation, and systemic therapy were compared. RESULTS: A total of 7954 SBA patients were identified; duodenum (D) 4607 (57.9%), jejunum (J) 1241 (15.6%), ileum (I) 857 (10.8%), and unspecified 1249 (15.7%). A total of 53.6% patients were male, and 76.6% white. Median age was 66 years. D mostly presented as stage IV disease (37.6%), J as stage II (34.5%) and IV disease (33.8%), and I as stage II (32.2%) and III (30.3%) disease (P < .001). Grade distribution was similar among D, J, and I; the majority were moderately differentiated (40.8%-55.0%), followed by poorly differentiated (30.9%-35.8%) and well differentiated (6.0%-12.4%) (P < .001). D underwent surgery (50.2%) less often than J (90.8%) and I (94.5%) (P < .001). Adjuvant radiation was provided in 8.5% of D, 2.6% of J, and 2.1% of I (P < .001). Adjuvant chemotherapy was provided in 21.9% of D, 50.2% of J, and 42.0% of I (P < .001). The rate of adjuvant chemotherapy was the highest in patients with stage III SBA, and was as follows: D (43.4%), J (65.4%), and I (63.6%) (P < .001). In univariate and multivariate analyses of all patients, adjuvant chemotherapy was associated with improved OS in stage II-III SBA patients. J had the best 5-year OS rate (42.0%; 95% confidence interval, 38.8-45.1, P < .001), and D had the worst (23.0%; 95% confidence interval, 21.6-24.2, P < .001). In multivariate analysis stratified by stage, chemotherapy was associated with improved OS in patients with stage II-IV SBA. CONCLUSION: Most SBA patients present with stage IV disease. D underwent surgery less often than J and I. Stage II and III D received adjuvant chemotherapy less often compared to stage II and III J and I. Adjuvant chemotherapy was associated with improved OS in patients with stage II-III disease. J had the best 5-year OS rate, and D had the worst. SN - 1938-0674 UR - https://www.unboundmedicine.com/medline/citation/31606297/Clinical_Outcomes_of_Small_Bowel_Adenocarcinoma L2 - https://linkinghub.elsevier.com/retrieve/pii/S1533-0028(19)30286-5 DB - PRIME DP - Unbound Medicine ER -