Adenocarcinoma of the small intestine: a multi-institutional study of 197 surgically resected cases

This work was presented in part at the 98th annual meeting of the United States & Canadian Academy of Pathology, Boston, MA, in March 2009.Small intestinal adenocarcinoma is a rare malignant neoplasm, and its clinicopathologic characteristics have not been well elucidated. A total of 197 small intestinal adenocarcinoma cases were collected from 22 institutions in South Korea and were evaluated for clinicopathologic factors that affect the prognosis of small intestinal adenocarcinoma patients using univariate and multivariate analyses. The mean patient age was 59 years, and the male-to-female ratio was 1.7:1. Tumors were located in the duodenum of 108 cases (55%), the jejunum in 59 (30%), and the ileum in 30 (15%). Predisposing conditions were observed in 23 cases (12%), including 17 cases with sporadic adenomas, 3 with Peutz-Jeghers syndrome, 2 with Meckel diverticulum, and 1 with Crohn disease. Synchronous or metachronous malignant tumors were identified in 31 cases (16%), including 13 colorectal and 10 stomach cancers. About 90% of tumors were classified as either pT3 (63 cases) or pT4 (112 cases). The median survival time for all small intestinal adenocarcinoma patients was 39.7 months. Compared with small intestinal adenocarcinomas without accompanying sporadic adenomas, small intestinal adenocarcinomas with accompanying adenomas were more well differentiated (P < .0001), with a more polypoid growth pattern (P < .0001), a lower pT classification (P < .0001), less perineural invasion (P = .01), and less lymphatic invasion (P = .03). Small intestinal adenocarcinoma patients with associated sporadic adenomas (77%) had a significantly better 5-year survival rate than those without sporadic adenomas (38%, P = .02). By univariate analysis, small intestinal adenocarcinoma patients had significantly different survival based on pT classification (P = .003), lymph node metastasis (P < .0001), distal location (jejuna] and ileal carcinomas) (P = .003), retroperitoneal tumor seeding (P < .0001), vascular invasion (P = .007), lymphatic invasion (P = .001), peritumoral dysplasia (P = .004), and radiation therapy (P = .006). By multivariate analysis, lymph node metastasis (P = .01) and distal location (P = .003) were independent predictors of a worse prognosis. In conclusion, (1) small intestinal adenocarcinomas are diagnosed at an advanced disease stage; therefore, the development of strategies for detection at an earlier stage is needed. (2) Small intestinal adenocarcinoma patients with an adenomatous component had a better survival than those without an adenomatous component. (3) Lymph node metastasis and distal location (jejunum and ileum) of tumor are the most important independent prognostic factors. (C) 2010 Elsevier Inc. All rights reserved.Bilimoria KY, 2009, ANN SURG, V249, P63, DOI [10.1097/SLA.0b013e31818c4641, 10.1097/SLA.0b013e31818e4641]Schottenfeld D, 2009, ANN EPIDEMIOL, V19, P58, DOI 10.1016/j.annepidem.2008.10.004Pennazio M, 2008, WORLD J GASTROENTERO, V14, P5245, DOI 10.3748/wjg.14.5245Rondonotti E, 2008, ENDOSCOPY, V40, P488, DOI 10.1055/s-2007-995783Jemal A, 2008, CA-CANCER J CLIN, V58, P71, DOI 10.3322/CA.2007.0010Cao J, 2008, J CLIN GASTROENTEROL, V42, P167Chaiyasate K, 2008, WORLD J SURG ONCOL, V6, DOI 10.1186/1477-7819-6-12Hatzaras I, 2007, ARCH SURG-CHICAGO, V142, P229Cobrin GM, 2006, CANCER, V107, P22, DOI 10.1002/cncr.21975Haselkorn T, 2005, CANCER CAUSE CONTROL, V16, P781, DOI 10.1007/s10552-005-3635-6Delaunoit T, 2005, AM J GASTROENTEROL, V100, P703, DOI 10.1111/j.1572-0241.2005.40605.xDabaja BS, 2004, CANCER, V101, P518GREENE FL, 2002, AJCC CANC STAGING MAHowe JR, 1999, CANCER, V86, P2693Neugut AI, 1998, CANCER EPIDEM BIOMAR, V7, P243Veyrieres M, 1997, AM J SURG, V173, P237Chow JS, 1996, INT J EPIDEMIOL, V25, P722Vasen HFA, 1996, GASTROENTEROLOGY, V110, P1020Severson RK, 1996, CANCER EPIDEM BIOMAR, V5, P81BEDENNE L, 1992, CANCER, V69, P883SELLNER F, 1990, CANCER, V66, P702FEARON ER, 1990, CELL, V61, P759WILLIAMS PT, 1989, GRAYS ANATOMYVOGELSTEIN B, 1988, NEW ENGL J MED, V319, P525ZOLLINGER RM, 1986, AM J SURG, V151, P654MUTO T, 1985, DIS COLON RECTUM, V28, P847PERZIN KH, 1981, CANCER, V48, P799WILSON JM, 1974, ANN SURG, V180, P175