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Adenocarcinoma of the small bowel
Author(s) -
Howe James R.,
Karnell Lucy H.,
Menck Herman R.,
ScottConner Carol
Publication year - 1999
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/(sici)1097-0142(19991215)86:12<2693::aid-cncr14>3.0.co;2-u
Subject(s) - medicine , duodenum , cancer , adenocarcinoma , proportional hazards model , gastroenterology , duodenal cancer , stage (stratigraphy) , multivariate analysis , jejunum , ileum , univariate analysis , colorectal cancer , disease , survival analysis , surgery , paleontology , biology
BACKGROUND Small bowel adenocarcinoma (SBA) accounts for 2% of gastrointestinal (GI) tumors and 1% of GI cancer deaths. The objective of this study was to review the National Cancer Data Base (NCDB) to identify case‐mix characteristics, patterns of treatment, and factors influencing survival of patients with SBA. METHODS NCDB data from patients diagnosed with primary SBA between 1985–1995 were analyzed. Chi‐square statistics were used to compare differences between groups. Disease specific survival (DSS) was calculated using the life table method for patients diagnosed between 1985–1990; univariate differences in survival were compared using the Wilcoxon statistic, and multivariate analyses were performed using a Cox regression model. RESULTS There were 4995 SBA cases reported to the NCDB between 1985–1995, 55% of which occurred in the duodenum, 18% in the jejunum, 13% in the ileum, and 14% in nonspecified sites. The overall 5‐year DSS was 30.5%, with a median survival of 19.7 months. By multivariate analysis, factors significantly correlated with DSS included patient age, tumor site, disease stage, and whether cancer‐directed surgery was performed. CONCLUSIONS SBA is found most commonly in the duodenum, and patient DSS is reduced at this site compared with those patients with jejunal or ileal tumors. This reduction in survival was associated with a lower percentage of cancer‐directed surgery. Patients age > 75 years had a reduced DSS and more duodenal tumors, and were less frequently treated by cancer‐directed surgery than their younger counterparts. This study reflects the experience with SBA from a large cross‐section of U.S. hospitals, allowing for the identification of prognostic factors and providing a reference with which results from single institutions may be compared. Cancer 1999;86:2693–706. © 1999 American Cancer Society.