Skip to main content

Advertisement

SpringerLink
Log in

Effect of postoperative radiotherapy on survival in duodenal adenocarcinoma: a propensity score-adjusted analysis of Surveillance, Epidemiology, and End Results database

  • Original Article
  • Published:
International Journal of Clinical Oncology Aims and scope Submit manuscript

Abstract

Purpose

The use of adjuvant treatment has not been sufficiently investigated in duodenal adenocarcinoma. This study evaluated the effect of postoperative radiotherapy (PORT) on survival outcomes in this rare malignancy.

Methods

We identified patients who were diagnosed between 2004 and 2013 in the Surveillance, Epidemiology, and End Results database. Overall survival (OS) and disease-specific survival (DSS) were analyzed before and after propensity score matching.

Results

Among the 701 eligible patients, 116 (17%) underwent PORT. There were no significant differences in OS and DSS according to receipt of PORT in the unmatched population (P = 0.982 and 0.496, respectively), whereas the propensity-matched analysis showed improved OS and DSS with PORT (P = 0.053 and 0.019, respectively). No receipt of PORT was an independent poor prognostic factor in multivariate analysis of both OS (P = 0.022) and DSS (P = 0.005). The potential survival benefits of PORT were observed in subgroups of T4 stage, larger tumor size, higher lymph node ratio, and total/radical resection.

Conclusions

We provide useful insights into the therapeutic role of PORT in adenocarcinoma of the duodenum. Adjuvant strategy with PORT needs to be considered in locally advanced tumors.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Surveillance, Epidemiology and End Results Program (2017) Cancer of the small intestine: cancer stat facts. https://seer.cancer.gov/statfacts/html/smint.html. Accessed 9 Oct 2017

  2. Jabbour SK, Mulvihill D (2014) Defining the role of adjuvant therapy: ampullary and duodenal adenocarcinoma. Semin Radiat Oncol 24:85–93

    Article  PubMed  Google Scholar 

  3. Cloyd JM, George E, Visser BC (2016) Duodenal adenocarcinoma: advances in diagnosis and surgical management. World J Gastrointest Surg 8:212–221

    Article  PubMed  PubMed Central  Google Scholar 

  4. Onkendi EO, Boostrom SY, Sarr MG et al (2012) 15-year experience with surgical treatment of duodenal carcinoma: a comparison of periampullary and extra-ampullary duodenal carcinomas. J Gastrointest Surg 16:682–691

    Article  PubMed  Google Scholar 

  5. Singhal N, Singhal D (2007) Adjuvant chemotherapy for small intestine adenocarcinoma. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD005202.pub2

    Article  PubMed  Google Scholar 

  6. Poultsides GA, Huang LC, Cameron JL et al (2012) Duodenal adenocarcinoma: clinicopathologic analysis and implications for treatment. Ann Surg Oncol 19:1928–1935

    Article  PubMed  Google Scholar 

  7. Kelsey CR, Nelson JW, Willett CG et al (2007) Duodenal adenocarcinoma: patterns of failure after resection and the role of chemoradiotherapy. Int J Radiat Oncol Biol Phys 69:1436–1441

    Article  PubMed  Google Scholar 

  8. Bakaeen FG, Murr MM, Sarr MG et al (2000) What prognostic factors are important in duodenal adenocarcinoma? Arch Surg 135:635–641

    Article  PubMed  CAS  Google Scholar 

  9. Kim K, Chie EK, Jang JY et al (2012) Role of adjuvant chemoradiotherapy for duodenal cancer: a single center experience. Am J Clin Oncol 35:533–536

    Article  PubMed  CAS  Google Scholar 

  10. Surveillance, Epidemiology and End Results Program (2017) About the SEER Program. http://seer.cancer.gov/about. Accessed 9 Oct 2017

  11. World Health Organization (2013) International classification of diseases for oncology, 3rd edn. World Health Organization, Geneva

    Google Scholar 

  12. Rosenbaum PR, Rubin DB (1983) The central role of the propensity score in observational studies for causal effects. Biometrika 70:41–55

    Article  Google Scholar 

  13. Rosenbaum PR, Rubin DB (1985) Constructing a control group using multivariate matched sampling methods that incorporate the propensity score. Am Stat 39:33–38

    Google Scholar 

  14. Austin PC (2011) An introduction to propensity score methods for reducing the effects of confounding in observational studies. Multivariate Behav Res 46:399–424

    Article  PubMed  PubMed Central  Google Scholar 

  15. Swartz MJ, Hughes MA, Frassica DA et al (2007) Adjuvant concurrent chemoradiation for node-positive adenocarcinoma of the duodenum. Arch Surg 142:285–288

    Article  PubMed  Google Scholar 

  16. Ecker BL, McMillan MT, Datta J et al (2016) Efficacy of adjuvant chemotherapy for small bowel adenocarcinoma: a propensity score-matched analysis. Cancer 122:693–701

    Article  PubMed  Google Scholar 

  17. Ecker BL, McMillan MT, Datta J et al (2017) Adjuvant chemotherapy versus chemoradiotherapy in the management of patients with surgically resected duodenal adenocarcinoma: a propensity score-matched analysis of a nationwide clinical oncology database. Cancer 123:967–976

    Article  PubMed  CAS  Google Scholar 

  18. Glynn RJ, Schneeweiss S, Sturmer T (2006) Indications for propensity scores and review of their use in pharmacoepidemiology. Basic Clin Pharmacol Toxicol 98:253–259

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  19. Mantripragada KC, Hamid F, Shafqat H et al (2017) Adjuvant therapy for resected gallbladder cancer: analysis of the national cancer data base. J Natl Cancer Inst 109:1–8

    Article  Google Scholar 

  20. Mitin T, Enestvedt CK, Jemal A et al (2017) Limited use of adjuvant therapy in patients with resected gallbladder cancer despite a strong association with survival. J Natl Cancer Inst 109:djw324

    Article  Google Scholar 

  21. Kaklamanos IG, Bathe OF, Franceschi D et al (2000) Extent of resection in the management of duodenal adenocarcinoma. Am J Surg 179:37–41

    Article  PubMed  CAS  Google Scholar 

  22. Overman MJ, Hu CY, Kopetz S et al (2012) A population-based comparison of adenocarcinoma of the large and small intestine: insights into a rare disease. Ann Surg Oncol 19:1439–1445

    Article  PubMed  Google Scholar 

  23. Wilhelm A, Muller SA, Steffen T et al (2016) Patients with adenocarcinoma of the small intestine with 9 or more regional lymph nodes retrieved have a higher rate of positive lymph nodes and improved survival. J Gastrointest Surg 20:401–410

    Article  PubMed  Google Scholar 

  24. Overman MJ, Hu CY, Wolff RA et al (2010) Prognostic value of lymph node evaluation in small bowel adenocarcinoma: analysis of the surveillance, epidemiology, and end results database. Cancer 116:5374–5382

    Article  PubMed  Google Scholar 

  25. Nicholl MB, Ahuja V, Conway WC et al (2010) Small bowel adenocarcinoma: understaged and undertreated? Ann Surg Oncol 17:2728–2732

    Article  PubMed  Google Scholar 

  26. Yovino S, Poppe M, Jabbour S et al (2011) Intensity-modulated radiation therapy significantly improves acute gastrointestinal toxicity in pancreatic and ampullary cancers. Int J Radiat Oncol Biol Phys 79:158–162

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Radiation Oncology, Kyung Hee University Medical Center, Kyung Hee University School of Medicine, 23 Kyungheedae-ro, Dongdaemoon-gu, Seoul, 02447, Republic of Korea

    Yu Jin Lim

  2. Department of Radiation Oncology, Ewha Womans University College of Medicine, 1071 Anyangcheon-ro, Yangcheon-gu, Seoul, 07985, Republic of Korea

    Kyubo Kim

Authors
  1. Yu Jin Lim
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kyubo Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kyubo Kim.

Ethics declarations

Conflict of interest

The authors declare no conflict of interest.

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lim, Y.J., Kim, K. Effect of postoperative radiotherapy on survival in duodenal adenocarcinoma: a propensity score-adjusted analysis of Surveillance, Epidemiology, and End Results database. Int J Clin Oncol 23, 473–481 (2018). https://doi.org/10.1007/s10147-017-1226-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10147-017-1226-7

Keywords

Search

Navigation