Abstract
Background
Small bowel adenocarcinoma (SBA) is a rare malignancy affecting approximately 3000
patients per year in the United States, and there is limited evidence prognosticating
patients with resected SBA. We aimed to evaluate prognostic factors and the role of
adjuvant therapy in patients with resected SBA.
Patients and Methods
Two hundred forty-one patients who had resected stage I-III SBA were retrospectively
identified at a single tertiary referral institution. Overall survival (OS) analysis
was performed by the Kaplan-Meier method, and Wilcoxon tests were used for statistical
comparisons. Cox proportional hazards were performed to identify significant variables
by univariate and multivariate analysis.
Results
Median OS for the entire group was 54.5 months (95% confidence interval [CI], 37.2-81.2
months), with 5- and 10-year OS of 48% and 35%. Median follow-up was 113.7 months
(95% CI, 97.9-126.6 months). For patients with stage III disease who received adjuvant
therapy, the median OS was 33.8 months (95% CI, 27.8-78.8) compared to 24.7 months
(95% CI, 11.5-37.8) for patients with no adjuvant therapy (P < .01). Male sex, advanced T stage, advanced N stage, increased positive lymph node
ratio, lymphocyte-to-monocyte ratio < 1.56, presence of residual disease, and earlier
date of diagnosis predicted worse survival on univariate analysis. Age > 60 years,
lymphocyte-to-monocyte ratio < 1.56, and advanced T stage were identified as independent
negative predictors of OS for all patients by multivariate analysis.
Conclusion
Advanced age, advanced T stage, and lymphocyte-to-monocyte ratio < 1.56 independently
predicted survival in resected SBA. Adjuvant therapy is associated with improved survival
in patients with resected stage III SBA.
Keywords
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Article info
Publication history
Published online: May 14, 2019
Accepted:
May 8,
2019
Received:
April 17,
2019
Identification
Copyright
© 2019 Elsevier Inc. All rights reserved.
