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Published on: December 1, 2012
Pediatric intestinal foregut and small bowel solid tumors: a review of 105 cases
Ying Zhuge1, Michael C Cheung, Relin Yang
1Division of Pediatric Surgery and Division of Surgical Oncology, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL 33136, USA.
Insights
Surgery significantly improves survival for pediatric intestinal solid tumors. Radiotherapy is crucial for carcinoma cases, highlighting the importance of timely and appropriate treatment for better outcomes in young patients.
Area of Science:
- Pediatric oncology
- Gastrointestinal surgery
- Cancer epidemiology
Background:
- Outcomes of pediatric intestinal foregut and small bowel solid tumors remain understudied on a population scale.
- Limited data exists on survival rates and prognostic factors for these rare pediatric malignancies.
Purpose of the Study:
- To analyze the population-level outcomes of pediatric intestinal foregut and small bowel solid tumors.
- To identify prognostic factors influencing survival in this patient cohort.
Main Methods:
- Utilized the Surveillance, Epidemiology, and End Results (SEER) database from 1973-2005.
- Included all patients under 20 years of age diagnosed with these specific tumor types.
- Performed univariate and multivariate analyses to determine survival predictors.
Main Results:
- Identified 105 cases; common sites were stomach (61%) and small bowel (30.5%).
- Sarcoma (43.8%) and carcinoma (41.0%) were most frequent histologies; most presented with advanced disease.
- Surgery improved survival, especially for gastric tumors; carcinoma histology predicted worse outcomes. African American race, advanced stage, and lack of surgery were independent predictors of poor survival.
Conclusions:
- Surgical intervention is significantly associated with improved survival for pediatric intestinal foregut and small bowel solid tumors.
- Radiotherapy is a critical adjuvant treatment for pediatric carcinoma of these sites.
- Timely surgical resection and consideration of radiotherapy are vital for optimizing outcomes.
Background:
The outcomes of pediatric intestinal foregut and small bowel solid tumors have never been studied on a population scale.
Materials And Methods:
The Surveillance, Epidemiology, and End Results database (1973-2005) was queried for all patients under 20 y of age.
Results:
A total of 105 cases of pediatric intestinal foregut and small bowel solid tumors were identified. Tumors occurred in the esophagus (8.6%), stomach (61%), and small bowel (30.5%). The most common histologies include sarcoma (43.8%), which consisted mostly of gastrointestinal stromal tumors (GIST), carcinoma (41.0%), which consisted mostly of adenocarcinomas, and neuroendocrine tumors (NET) (10.5%). Most tumors were poorly differentiated and presented with advanced disease. The overall median survival time was 207 mo. Gastric solid tumors had significantly worse 5- and 10-y survival compared with their small bowel counterparts, though this difference disappeared in those who received surgical resection. Patients with carcinoma had significantly worse survival compared with those with sarcoma or NET, regardless of site and surgical intervention. Univariate analysis identified race, differentiation, stage, and surgery as significant predictors of survival. Multivariate analysis revealed that African American race, advanced stage of disease, carcinoma histology, and failure to undergo surgical extirpation were all independent predictors of worse outcome. In patients with carcinoma, failure to undergo radiotherapy was also a predictor of worse outcome.
Conclusion:
Surgery is associated with a significantly improved survival for pediatric patients with solid tumors of the intestinal foregut and small bowel. Radiotherapy appears to be an important adjuvant therapy for patients with carcinoma.
