Clinicopathological features and prognosis of primary small bowel adenocarcinoma: a large multicenter analysis of the JSCCR database in Japan,Journal of Gastroenterology

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Clinicopathological features and prognosis of primary small bowel adenocarcinoma: a large multicenter analysis of the JSCCR database in Japan
Journal of Gastroenterology ( IF 6.3 ) Pub Date : 2024-02-27 , DOI: 10.1007/s00535-024-02081-3
Ken Yamashita , Shiro Oka , Takeshi Yamada , Keigo Mitsui , Hironori Yamamoto , Keiichi Takahashi , Akio Shiomi , Kinichi Hotta , Yoji Takeuchi , Toshio Kuwai , Fumio Ishida , Shin-Ei Kudo , Shoichi Saito , Masashi Ueno , Eiji Sunami , Tomoki Yamano , Michio Itabashi , Kazuo Ohtsuka , Yusuke Kinugasa , Takayuki Matsumoto , Tamotsu Sugai , Toshio Uraoka , Koichi Kurahara , Shigeki Yamaguchi , Tomohiro Kato , Masazumi Okajima , Hiroshi Kashida , Yoshito Akagi , Hiroaki Ikematsu , Masaaki Ito , Motohiro Esaki , Masaya Kawai , Takashi Yao , Madoka Hamada , Takahiro Horimatsu , Keiji Koda , Yasumori Fukai , Koji Komori , Yusuke Saitoh , Yukihide Kanemitsu , Hiroyuki Takamaru , Kazutaka Yamada , Hiroaki Nozawa , Tetsuji Takayama , Kazutomo Togashi , Eiji Shinto , Takehiro Torisu , Akira Toyoshima , Naoki Ohmiya , Takeshi Kato , Eigo Otsuji , Shinji Nagata , Yojiro Hashiguchi , Kenichi Sugihara , Yoichi Ajioka , Shinji Tanaka

Background

The clinicopathological features and prognosis of primary small bowel adenocarcinoma (PSBA), excluding duodenal cancer, remain undetermined due to its rarity in Japan.

Methods

We analyzed 354 patients with 358 PSBAs, between January 2008 and December 2017, at 44 institutions affiliated with the Japanese Society for Cancer of the Colon and Rectum.

Results

The median age was 67 years (218 males, 61.6%). The average tumor size was 49.9 (7–100) mm. PSBA sites consisted of jejunum (66.2%) and ileum (30.4%). A total of 219 patients (61.9%) underwent diagnostic small bowel endoscopy, including single-balloon endoscopy, double-balloon endoscopy, and capsule endoscopy before treatment. Nineteen patients (5.4%) had Lynch syndrome, and 272 patients (76.8%) had symptoms at the initial diagnosis. The rates for stages 0, I, II, III, and IV were 5.4%, 2.5%, 27.1%, 26.0%, and 35.6%, respectively. The 5-year overall survival rates at each stage were 92.3%, 60.0%, 75.9%, 61.4%, and 25.5%, respectively, and the 5-year disease-specific survival (DSS) rates were 100%, 75.0%, 84.1%, 59.3%, and 25.6%, respectively. Patients with the PSBA located in the jejunum, with symptoms at the initial diagnosis or advanced clinical stage had a worse prognosis. However, multivariate analysis using Cox-hazard model revealed that clinical stage was the only significant predictor of DSS for patients with PSBA.

Conclusions

Of the patients with PSBA, 76.8% had symptoms at the initial diagnosis, which were often detected at an advanced stage. Detection during the early stages of PSBA is important to ensure a good prognosis.

中文翻译：

原发性小肠腺癌的临床病理特征和预后：日本 JSCCR 数据库的大型多中心分析

背景

原发性小肠腺癌（PSBA）（不包括十二指肠癌）由于其在日本罕见，其临床病理特征和预后仍不确定。

方法

我们分析了 2008 年 1 月至 2017 年 12 月期间日本结直肠癌协会附属 44 个机构的 354 名患者，其中有 358 个 PSBA。

结果

中位年龄为 67 岁（218 名男性，61.6%）。肿瘤平均大小为 49.9 (7–100) mm。PSBA 部位包括空肠 (66.2%) 和回肠 (30.4%)。共有219名患者（61.9%）在治疗前接受了诊断性小肠内镜检查，包括单气囊内镜检查、双气囊内镜检查和胶囊内镜检查。19 名患者（5.4%）患有林奇综合征，272 名患者（76.8%）在初次诊断时出现症状。0、I、II、III 和 IV 期的发生率分别为 5.4%、2.5%、27.1%、26.0% 和 35.6%。各阶段5年总生存率分别为92.3%、60.0%、75.9%、61.4%和25.5%，5年疾病特异性生存率（DSS）分别为100%、75.0%、84.1分别为 %、59.3% 和 25.6%。PSBA位于空肠、初诊时或临床晚期就有症状的患者预后较差。然而，使用 Cox-hazard 模型的多变量分析表明，临床分期是 PSBA 患者 DSS 的唯一显着预测因子。