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Small bowel adenocarcinoma: understaged and undertreated?
Michael B Nicholl1, Vanita Ahuja, W Charles Conway
1John Wayne Cancer Institute at Saint John's Health Center, Santa Monica, CA, USA.
Background:
Primary small bowel adenocarcinoma (SBA) is a rare, chemoresistant tumor with an aggressive clinical nature. Surgery is the mainstay of therapy, but the extent of lymph node (LN) recovery necessary for optimal care of jejunoileal SBA is unknown.
Materials And Methods:
The SEER database was queried to identify patients whose primary jejunoileal SBA was diagnosed between 1995 and 2005. Patients were grouped by AJCC stage and number of LNs recovered from the surgical specimen.
Results:
Of 1444 patients with primary SBA, 93 (6.4%), 529 (36.6%), 356 (24.7%), and 466 (32.3%) were initially diagnosed with stage I, II, III, and IV disease, respectively. Five-year overall survival (OS) rate was 59.8%, 39.5%, 27.0%, and 3.2% for patients with stage I, II, III, and IV SBA, respectively. When ≥10 nodes were recovered, OS rate increased nonsignificantly in stage I (73.2% vs. 55.6%) and significantly in stage II (61.8% vs. 32.9%, P < .001) but was unchanged in stage III (27.4% vs. 27.3%, P = .13). Recovery of ≥10 nodes occurred in 26.9%, 23.6%, and 42.1% of patients with stage I, II, and III SBA, respectively. Multivariate analysis identified age, AJCC stage, site of primary tumor, recovery of ≥10 LNs, and number of positive nodes as significant for OS.
Conclusions:
We have found SBA staging is largely inadequate. Our results suggest recovery of ≥10 LNs ensures accurate staging. Improvement in stage II SBA OS after adequate LN may reflect a high degree of understaging in this dataset rather than a therapeutic effect of LAD.
Insights
Adequate lymph node (LN) recovery in small bowel adenocarcinoma (SBA) surgery is crucial for accurate staging. Recovering at least 10 LNs improves staging accuracy and may impact survival outcomes for stage II SBA patients.
Area of Science:
- Oncology
- Surgical Oncology
- Gastroenterology
Background:
- Primary small bowel adenocarcinoma (SBA) is a rare cancer.
- SBA is known for chemoresistance and aggressive behavior.
- Optimal lymph node (LN) recovery for jejunoileal SBA is not well-defined.
Purpose of the Study:
- To determine the impact of lymph node recovery extent on staging and survival in small bowel adenocarcinoma.
- To evaluate if recovering a minimum number of lymph nodes improves prognostic accuracy.
Main Methods:
- Utilized the SEER database for jejunoileal SBA cases diagnosed between 1995-2005.
- Analyzed patient data based on AJCC stage and the number of lymph nodes recovered.
- Performed multivariate analysis to identify significant prognostic factors for overall survival.
Main Results:
- Overall survival rates varied significantly by stage: Stage I (59.8%), II (39.5%), III (27.0%), and IV (3.2%).
- Recovering ≥10 LNs showed a significant survival improvement in Stage II SBA (61.8% vs. 32.9%, P < .001).
- Multivariate analysis identified LN recovery (≥10 LNs) as a significant factor for overall survival.
Conclusions:
- Current small bowel adenocarcinoma staging appears inadequate.
- Recovering at least 10 lymph nodes is recommended for accurate staging.
- Observed survival improvements in Stage II SBA with adequate LN recovery may indicate prior understaging.
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