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Adenocarcinoma of the small intestine: a multi-institutional study of 197 surgically resected cases

Cited 54 time in Web of Science Cited 56 time in Scopus
Authors
Chang, Hee-Kyung; Yu, Eunsil; Kim, Jihun; Bae, Young Kyung; Jung, Eun Sun; Kim, Joon Mee; Bae, Han-Ik; Jung, Soo Jin; Kim, Jung Yeon; Park, Jason Y.; Lee, Ji Shin; Hong, SoonWon; Park, Jae Bok; Kang, Gyeong Hoon; Kwon, Kye Won; Eom, Dae Woon; Jun, Sun-Young; Jang, Kyu Yun; Hong, Seung-Mo; Gu, Mi Jin; Kim, Gwang Il; Oh, Young-Ha; Yoon, Ghil Suk; Jang, Kee-Taek
Issue Date
2010-08
Publisher
W B SAUNDERS CO-ELSEVIER INC
Citation
HUMAN PATHOLOGY; Vol.41 8; 1087-1096
Keywords
Small intestinePrognosisAdenocarcinomaAdenomaSurvival
Description
This work was presented in part at the 98th annual meeting of the United States & Canadian Academy of Pathology, Boston, MA, in March 2009.
Abstract
Small intestinal adenocarcinoma is a rare malignant neoplasm, and its clinicopathologic characteristics have not been well elucidated. A total of 197 small intestinal adenocarcinoma cases were collected from 22 institutions in South Korea and were evaluated for clinicopathologic factors that affect the prognosis of small intestinal adenocarcinoma patients using univariate and multivariate analyses. The mean patient age was 59 years, and the male-to-female ratio was 1.7:1. Tumors were located in the duodenum of 108 cases (55%), the jejunum in 59 (30%), and the ileum in 30 (15%). Predisposing conditions were observed in 23 cases (12%), including 17 cases with sporadic adenomas, 3 with Peutz-Jeghers syndrome, 2 with Meckel diverticulum, and 1 with Crohn disease. Synchronous or metachronous malignant tumors were identified in 31 cases (16%), including 13 colorectal and 10 stomach cancers. About 90% of tumors were classified as either pT3 (63 cases) or pT4 (112 cases). The median survival time for all small intestinal adenocarcinoma patients was 39.7 months. Compared with small intestinal adenocarcinomas without accompanying sporadic adenomas, small intestinal adenocarcinomas with accompanying adenomas were more well differentiated (P < .0001), with a more polypoid growth pattern (P < .0001), a lower pT classification (P < .0001), less perineural invasion (P = .01), and less lymphatic invasion (P = .03). Small intestinal adenocarcinoma patients with associated sporadic adenomas (77%) had a significantly better 5-year survival rate than those without sporadic adenomas (38%, P = .02). By univariate analysis, small intestinal adenocarcinoma patients had significantly different survival based on pT classification (P = .003), lymph node metastasis (P < .0001), distal location (jejuna] and ileal carcinomas) (P = .003), retroperitoneal tumor seeding (P < .0001), vascular invasion (P = .007), lymphatic invasion (P = .001), peritumoral dysplasia (P = .004), and radiation therapy (P = .006). By multivariate analysis, lymph node metastasis (P = .01) and distal location (P = .003) were independent predictors of a worse prognosis. In conclusion, (1) small intestinal adenocarcinomas are diagnosed at an advanced disease stage; therefore, the development of strategies for detection at an earlier stage is needed. (2) Small intestinal adenocarcinoma patients with an adenomatous component had a better survival than those without an adenomatous component. (3) Lymph node metastasis and distal location (jejunum and ileum) of tumor are the most important independent prognostic factors. (C) 2010 Elsevier Inc. All rights reserved.
ISSN
0046-8177
Language
English
URI
http://hdl.handle.net/10371/76662
DOI
https://doi.org/10.1016/j.humpath.2010.01.006
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College of Medicine/School of Medicine (의과대학/대학원)Pathology (병리학전공)Journal Papers (저널논문_병리학전공)
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