Impact of Tumor Location on Patient Outcomes in Small Bowel Cancers

Published:November 30, 2021DOI:



      Small bowel cancers are rare gastrointestinal malignancies and tumor location impact on outcomes is unclear.

      Material and Methods

      A retrospective review was performed on stage I to IV small bowel cancer cases from 2000 to 2017 in British Columbia, Canada. Baseline patient characteristics, disease-free survival (DFS) and overall survival (OS) were evaluated by tumor location and systemic therapy use patterns were summarized.


      Of 340 patients included, primary tumor distribution was: duodenum (51.2%), ileum (19.1%), jejunum (18.5%), and unspecified (11.2%). Median DFS for stage I to III disease was 37.7, 49.1, and 26.7 months for duodenal, jejunal, and ileal tumors (P = .018). Median OS was 9.6, 35.2, and 20.1 months for duodenal, jejunal, and ileal tumors (P < .0001). Compared to duodenal primaries, both jejunal and ileal tumors were associated with significantly improved OS (HR 0.43, P < .001 for jejunal; HR 0.71, P = .035 for ileal). Adjuvant therapy was given to 21.6% of stage II and 50.6% of stage III cancers. Among patients with metastatic disease, median OS was 4.2, 11.4, and 6.9 months for duodenal, jejunal, and ileal tumors (P = .0019). Jejunal tumors had the best prognosis (HR 0.48, P = .001 vs. duodenum).


      Survival differences exist when small bowel cancers were assessed by tumor location, and jejunal tumors portended better prognosis overall.


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        • National Cancer Institute
        Surveillance, Epidemiology, and End Results Program.
        Cancer Stat Facts: Small Intestine Cancer, 2020 (Available at) (Accessed July 3)
        • Bilimoria KY
        • Bentrem DJ
        • Wayne JD
        • et al.
        Small bowel cancer in the United States: changes in epidemiology, treatment, and survival over the last 20 years.
        Ann Surg. 2009; 249: 63-71
        • Kiela PR
        • Ghishan FK.
        Physiology of intestinal absorption and secretion.
        Best Pract Res Clin Gastroenterol. 2016; 30: 145-159
        • National Cancer Institute
        Surveillance, Epidemiology, and End Results Program.
        Cancer Stat Facts: Colorectal Cancer, 2020 (Available at) (Accessed July 11)
        • Raghav K
        • Overman MJ.
        Small bowel adenocarcinomas–existing evidence and evolving paradigms.
        Nat Rev Clin Oncol. 2013; 10: 534-544
        • Schrock AB
        • Devoe CE
        • McWilliams R
        • et al.
        Genomic profiling of small-bowel adenocarcinoma.
        JAMA Oncol. 2017; 3: 1546-1553
        • Overman MJ
        • Pozadzides J
        • Kopetz S
        • et al.
        Immunophenotype and molecular characterisation of adenocarcinoma of the small intestine.
        Br J Cancer. 2010; 102: 144-150
        • Peltomäki P.
        Deficient DNA mismatch repair: A common etiologic factor for colon cancer.
        Hum Mol Genet. 2001; 10: 735-740
        • Dabaja BS
        • Suki D
        • Pro B
        • et al.
        Adenocarcinoma of the small bowel: presentation, prognostic factors, and outcome of 217 patients.
        Cancer. 2004; 101: 518-526
        • Halfdanarson TR
        • McWilliams RR
        • Donohue JH
        • et al.
        A single-institution experience with 491 cases of small bowel adenocarcinoma.
        Am J Surg. 2010; 199: 797-803
        • Lee TC
        • Wima K
        • Morris MC
        • et al.
        Small bowel adenocarcinomas: impact of location on survival.
        J Surg Res. 2020; 252: 116-124
        • Lee MKC
        • Loree JM.
        Current and emerging biomarkers in metastatic colorectal cancer.
        Curr Oncol. 2019; 26: S7-S15
        • Edge SB
        • Compton CC.
        The american joint committee on cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM.
        Ann Surg Oncol. 2010; 17: 1471-1474
      1. BC Cancer Genetics and Genomics Laboratory. Oncopanel (Solid Tumor NGS Panel). Available at Accessed August 12, 2020.

      2. RARECARE. Surveillance of rare cancers in Europe. Available at Accessed August 7, 2020.

        • Overman MJ
        • Hu CY
        • Kopetz S
        • et al.
        A population-based comparison of adenocarcinoma of the large and small intestine: Insights into a rare disease.
        Ann Surg Oncol. 2012; 19: 1439-1445
        • Howe JR
        • Karnell LH
        • Menck HR
        • et al.
        The American College of Surgeons Commission on Cancer and the American Cancer Society. Adenocarcinoma of the small bowel: review of the National Cancer Data Base, 1985-1995.
        Cancer. 1999; 86: 2693-2706
        • Overman MJ
        • Hu C
        • Wolff RA
        • et al.
        Prognostic value of lymph node evaluation in small bowel adenocarcinoma.
        Cancer. 2010; 116: 5374-5382
        • Zar N
        • Holmberg L
        • Wilander E
        • et al.
        Survival in small intestinal adenocarcinoma.
        Eur J Cancer. 1996; 32A: 2114-2119
        • Aparicio T
        • Henriques J
        • Manfredi S
        • et al.
        Small bowel adenocarcinoma: Results from a nationwide prospective ARCAD-NADEGE cohort study of 347 patients.
        Int J Cancer. 2020; 147: 967-977
        • Tejpar S
        • Stintzing S
        • Ciardiello F
        • et al.
        Prognostic and predictive relevance of primary tumor location in patients with RAS wild-type metastatic colorectal cancer: Retrospective analyses of the CRYSTAL and FIRE-3 trials.
        JAMA Oncol. 2017; 3: 194-201
        • Venook AP
        • Niedzwiecki D
        • Innocenti F
        • et al.
        Impact of primary (1°) tumor location on overall survival (OS) and progression-free survival (PFS) in patients (pts) with metastatic colorectal cancer (mCRC): Analysis of CALGB/SWOG 80405 (Alliance).
        J Clin Oncol. 2016; 34 (Abstract 3504)
        • Shaukat A
        • Virnig DJ
        • Howard D
        • et al.
        Crohn's disease and small bowel adenocarcinoma: a population-based case–control study.
        Cancer Epidemiol Biomarkers Prev. 2011; 20: 1120-1123
        • Legué LM
        • Bernards N
        • Gerritse SL
        • et al.
        Trends in incidence, treatment and survival of small bowel adenocarcinomas between 1999 and 2013: a population-based study in The Netherlands.
        Acta Oncol. 2016; 55: 1183-1189
        • Laforest A
        • Aparicio T
        • Zaanan A
        • et al.
        ERBB2 gene as a potential therapeutic target in small bowel adenocarcinoma.
        Eur J Cancer. 2014; 50: 1740-1746
        • Adediran SG
        • Shah U
        • Gheith S
        • et al.
        Her2 expression in small bowel adenocarcinoma.
        J Clin Oncol. 2018; 36 (Abstract e16261)
        • Aparicio T
        • Svrcek S
        • Henriques J
        • et al.
        Panel gene profiling of small bowel adenocarcinoma: Results from the NADEGE prospective cohort.
        Int J Cancer. 2021; 148: 1731-1742
        • Ecker BL
        • McMillan MT
        • Datta J
        • et al.
        Efficacy of adjuvant chemotherapy for small bowel adenocarcinoma: a propensity score-matched analysis.
        Cancer. 2016; 122: 693-701
        • Evans TRJ
        • Aparicio T
        • Le Malicot K
        • et al.
        GLOBAL BALLAD: An international rare cancers initiative trial to evaluate the potential benefit of adjuvant chemotherapy for small bowel adenocarcinoma (IRCI 002).
        J Clin Oncol. 2016; 34 (suppl 15):Abstract TPS4154
        • Overman MJ
        • Kopetz S
        • Wen S
        • et al.
        Chemotherapy with 5-fluorouracil and a platinum compound improves outcomes in metastatic small bowel adenocarcinoma.
        Cancer. 2008; 113: 2038-2045
        • Zaanan A
        • Costes L
        • Gauthier M
        • et al.
        Chemotherapy of advanced small-bowel adenocarcinoma: a multicenter AGEO study.
        Ann Oncol. 2010; 21: 1786-1793
        • McWilliams RR
        • Foster NR
        • Mahoney MR
        • et al.
        North Central Cancer Treatment Group N0543 (Alliance): A phase 2 trial of pharmacogenetic-based dosing of irinotecan, oxaliplatin, and capecitabine as first-line therapy for patients with advanced small bowel adenocarcinoma.
        Cancer. 2017; 123: 3494-3501
        • Xiang XJ
        • Liu YW
        • Zhang L
        • et al.
        A phase II study of modified FOLFOX as first-line chemotherapy in advanced small bowel adenocarcinoma.
        Anticancer Drugs. 2012; 23: 561-566
        • Overman MJ
        • Varadhachary GR
        • Kopetz S
        • et al.
        Phase II study of capecitabine and oxaliplatin for advanced adenocarcinoma of the small bowel and ampulla of Vater.
        J Clin Oncol. 2009; 27: 2598-2603
        • Gibson MK
        • Holcroft CA
        • Kvols LK
        • et al.
        Phase II study of 5-fluorouracil, doxorubicin, and mitomycin C for metastatic small bowel adenocarcinoma.
        Oncologist. 2005; 10: 132-137
        • Latham A
        • Shia J
        • Patel Z
        • et al.
        Characterization and clinical outcomes of DNA mismatch repair-deficient small bowel adenocarcinoma.
        Clin Cancer Res. 2021; 27: 1429-1437