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Duodenal localization is a negative predictor of survival after small bowel adenocarcinoma resection: A population-based, propensity score-matched analysis

Alexander Wilhelm, Christian Galata, Ulrich Beutner, Bruno Schmied, Rene Warschkow, Thomas Steffen, Walter Brunner, Stefan Post & Lukas Marti

abstract

BACKGROUND AND OBJECTIVES
This study assessed the influence of tumor localization of small bowel adenocarcinoma on survival after surgical resection.

METHODS
Patients with resected small bowel adenocarcinoma, ACJJ stage I-III, were identified from the Surveillance, Epidemiology, and End Results database from 2004 to 2013. The impact of tumor localization on overall and cancer-specific survival was assessed using Cox proportional hazard regression models with and without risk-adjustment and propensity score methods.

RESULTS
Adenocarcinoma was localized to the duodenum in 549 of 1025 patients (53.6%). There was no time trend for duodenal localization (P = 0.514). The 5-year cancer-specific survival rate was 48.2% (95%CI: 43.3-53.7%) for patients with duodenal carcinoma and 66.6% (95%CI: 61.6-72.1%) for patients with cancer located in the jejunum or ileum. Duodenal localization was associated with worse overall and cancer-specific survival in univariable (HR = 1.73; HR = 1.81, respectively; both P < 0.001), multivariable (HR = 1.52; HR = 1.65; both P < 0.001), and propensity score-adjusted analyses (HR = 1.33, P = 0.012; HR = 1.50, P = 0.002). Furthermore, young age, retrieval of more than 12 regional lymph nodes, less advanced stage, and married matrimonial status were positive, independent prognostic factors.

CONCLUSIONS
Duodenal localization is an independent risk factor for poor survival after resection of adenocarcinoma.
   
citation Wilhelm A, Galata C, Beutner U, Schmied B, Warschkow R, Steffen T, Brunner W, Post S, Marti L. Duodenal localization is a negative predictor of survival after small bowel adenocarcinoma resection: A population-based, propensity score-matched analysis. J Surg Oncol 2017;.
   
type journal paper/review (English)
date of publishing 16-10-2017
journal title J Surg Oncol
ISSN electronic 1096-9098
PubMed 29044591
DOI 10.1002/jso.24877