Clinicopathological features and prognosis of primary small bowel adenocarcinoma: a large multicenter analysis of the JSCCR database in Japan

BACKGROUND

The clinicopathological features and prognosis of primary small bowel adenocarcinoma (PSBA), excluding duodenal cancer, remain undetermined due to its rarity in Japan.

METHODS

We analyzed 354 patients with 358 PSBAs, between January 2008 and December 2017, at 44 institutions affiliated with the Japanese Society for Cancer of the Colon and Rectum.

RESULTS

The median age was 67 years (218 males, 61.6%). The average tumor size was 49.9 (7-100) mm. PSBA sites consisted of jejunum (66.2%) and ileum (30.4%). A total of 219 patients (61.9%) underwent diagnostic small bowel endoscopy, including single-balloon endoscopy, double-balloon endoscopy, and capsule endoscopy before treatment. Nineteen patients (5.4%) had Lynch syndrome, and 272 patients (76.8%) had symptoms at the initial diagnosis. The rates for stages 0, I, II, III, and IV were 5.4%, 2.5%, 27.1%, 26.0%, and 35.6%, respectively. The 5-year overall survival rates at each stage were 92.3%, 60.0%, 75.9%, 61.4%, and 25.5%, respectively, and the 5-year disease-specific survival (DSS) rates were 100%, 75.0%, 84.1%, 59.3%, and 25.6%, respectively. Patients with the PSBA located in the jejunum, with symptoms at the initial diagnosis or advanced clinical stage had a worse prognosis. However, multivariate analysis using Cox-hazard model revealed that clinical stage was the only significant predictor of DSS for patients with PSBA.

CONCLUSIONS

Of the patients with PSBA, 76.8% had symptoms at the initial diagnosis, which were often detected at an advanced stage. Detection during the early stages of PSBA is important to ensure a good prognosis.

Clinical characteristics of primary small bowel adenocarcinoma

BACKGROUND

Adenocarcinoma of the small bowel is rare in comparison with other gastrointestinal malignancies but its incidence is rising. The non-specific symptoms with which they present often pose a high rate of missed diagnosis and misdiagnosis. It is of great significance to explore the clinical characteristics of small bowel adenocarcinoma in order to improve its early diagnosis and prognosis.

AIM

To analyze the clinical characteristic of primary small bowel adenocarcinoma, in order to improve its early diagnosis and prognosis.

METHODS

From January 2012 to September 2017, 98 patients with pathologically diagnosed primary small bowel adenocarcinoma at the First Affiliated Hospital of Zhengzhou University were retrospectively enrolled.

RESULTS

There were 58, 29, and 11 cases of adenocarcinoma in the duodenum, jejunum, and ileum, respectively. The common clinical manifestations included abdominal pain (47 cases), jaundice (31 cases), intestinal obstruction (25 cases), and gastrointestinal bleeding (7 cases). The examination methods included digestive tract angiography, CT, endoscopy and so on. Preoperative misdiagnosis occurred in 35 (35.7%) cases. Univariate analysis showed that misdiagnosis was related to tumor location, growth pattern, and tumor size (P < 0.05). Ninety-six patients underwent surgical treatment.

CONCLUSION

The preoperative misdiagnosis rate of primary small bowel adenocarcinoma is high due to the absence of specific clinical manifestations. The main therapy is still surgery.