Metastatic Characteristics and Prognosis of Small Bowel Adenocarcinoma / 胃肠病学

ABSTRACT

Background: The morbidity of small bowel adenocarcinoma (SBA) in gastrointestinal neoplasms is relatively low, and there are few studies focusing on the clinicopathological features and prognostic data of SBA both at home and abroad. Aims: To investigate the metastatic characteristics and prognosis of patients with SBA. Methods: Patients with SBA were identified from the Surveillance, Epidemiology, and End Results (SEER) database from 2010 to 2016. Data on metastatic patterns, clinicopathological features and prognosis were extracted and analyzed, and the prognostic factors were assessed by Cox proportional hazard model. Results: A total of 2 489 cases of SBA were identified, of which 448 cases (18.0%) had liver metastasis, 48 (1.9%) had bone metastasis, and 129 (5.2%) had lung metastasis. Different metastatic sites were associated with different clinicopathological parameters. There were no significant differences in bone or lung metastasis between patients with and without liver metastasis (P>0.05). The median overall survival (OS) of patients with liver, bone, and lung metastasis was 6, 4, and 8 months, respectively, all were shorter than that of patients without metastasis at corresponding site (P<0.05). Surgical resection of primary tumor improved the OS of patients without metastasis and with liver metastasis, but had no effect on OS of patients with lung or liver plus lung metastases. Multivariate analysis showed that aged more than 66 years, poorly differentiated and undifferentiated tumors, and lymph node metastasis were independent risk factors for poor prognosis, while married and surgical resection of primary tumor were protective factors. Conclusions: SBA patients with metastasis had a poorer OS than those without. Different metastatic characteristics are associated with different prognosis. Liver is an important distant metastatic organ for SBA. For SBA patients, married and surgical resection of primary tumor are beneficial factors, whereas advanced age, poorly differentiated, undifferentiated, and lymph node metastasis are predictors of poor prognosis.