Abstract
Background
Because of its rarity, adenocarcinoma of the small intestine is frequently compared to adenocarcinoma of the colon, although the validity of this comparison is not known.
Methods
Patients with small and large bowel adenocarcinoma (SBA and LBA) diagnosed between 1988 and 2007 were identified from the Surveillance, Epidemiology, and End Results registry. Age-standardized incidence and mortality rates were determined. Cancer-specific survival (CSS) stratified by stage and by number of assessed lymph nodes was calculated.
Results
A total of 4518 and 261,521 patients with SBA and LBA, respectively, were identified. In comparison to LBA, patients with SBA were younger and presented with disease of higher stage and histologic grade. The age-standardized incidence rates decreased for LBA (−1.24% per year) but increased for SBA (+1.47% per year). Although age-standardized mortality rates decreased for both LBA and SBA, the decreases were more pronounced for LBA. Five-year CSS was worse for resected SBA compared with resected LBA, although this difference diminished when comparing cases having eight or more lymph nodes assessed. The relative reduction in CSS when selecting eight or more lymph nodes was much greater for duodenal as opposed to jejunal/ileal subsite of the small bowel. With nodal selection the absolute difference in CSS between LBA and SBA for stages I, II, and III was 13, 15.9, and 18.5%, respectively.
Conclusions
Adequate nodal assessment is much less common in SBA than LBA; and it appears that SBA, in particular duodenal adenocarcinoma, is understaged. Even after corrections to minimize the effect of stage migration and inadequate lymph node evaluation, SBA demonstrated distinctly worse CSS than LBA.
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References
Bilimoria KY, Bentrem DJ, Wayne JD, et al. Small bowel cancer in the United States: changes in epidemiology, treatment, and survival over the last 20 years. Ann Surg. 2009;249:63–71.
Jemal A, Siegel R, Ward E, et al. Cancer statistics, 2009. CA Cancer J Clin. 2009;59:225–49.
Agrawal S, McCarron EC, Gibbs JF, et al. Surgical management and outcome in primary adenocarcinoma of the small bowel. Ann Surg Oncol. 2007;14:2263–9.
Howe JR, Karnell LH, Menck HR, Scott-Conner C; The American College of Surgeons Commission on Cancer and the American Cancer Society. Adenocarcinoma of the small bowel: review of the National Cancer Data Base, 1985–1995. Cancer. 1999;86:2693–706.
Wu TJ, Yeh CN, Chao TC, et al. Prognostic factors of primary small bowel adenocarcinoma: univariate and multivariate analysis. World J Surg. 2006;30:391–8.
Overman MJ, Varadhachary GR, Kopetz S, et al. Phase II study of capecitabine and oxaliplatin for advanced adenocarcinoma of the small bowel and ampulla of Vater. J Clin Oncol. 2009;27:2598–603.
Sellner F. Investigations on the significance of the adenoma-carcinoma sequence in the small bowel. Cancer. 1990;66:702–15.
Perzin KH, Bridge MF. Adenomas of the small intestine: a clinicopathologic review of 51 cases and a study of their relationship to carcinoma. Cancer. 1981;48:799–819.
Blaker H, von Herbay A, Penzel R, et al. Genetics of adenocarcinomas of the small intestine: frequent deletions at chromosome 18q and mutations of the SMAD4 gene. Oncogene. 2002;21:158–64.
Nishiyama K, Yao T, Yonemasu H, et al. Overexpression of p53 protein and point mutation of K-ras genes in primary carcinoma of the small intestine. Oncol Rep. 2002;9:293–300.
Zhang MQ, Chen ZM, Wang HL. Immunohistochemical investigation of tumorigenic pathways in small intestinal adenocarcinoma: a comparison with colorectal adenocarcinoma. Mod Pathol. 2006;19:573–80.
Blaker H, Helmchen B, Bonisch A, et al. Mutational activation of the RAS-RAF-MAPK and the Wnt pathway in small intestinal adenocarcinomas. Scand J Gastroenterol. 2004;39:748–53.
Rashid A, Hamilton SR. Genetic alterations in sporadic and Crohn’s-associated adenocarcinomas of the small intestine. Gastroenterology. 1997;113:127–35.
Arai M, Shimizu S, Imai Y, et al. Mutations of the Ki-ras, p53 and APC genes in adenocarcinomas of the human small intestine. Int J Cancer. 1997;70:390–5.
Miyaki M, Konishi M, Kikuchi-Yanoshita R, et al. Characteristics of somatic mutation of the adenomatous polyposis coli gene in colorectal tumors. Cancer Res. 1994;54:3011–20.
Miyoshi Y, Nagase H, Ando H, et al. Somatic mutations of the APC gene in colorectal tumors: mutation cluster region in the APC gene. Hum Mol Genet. 1992;1:229–33.
River L, Silverstein J, Tope JW. Benign neoplasms of the small intestine; a critical comprehensive review with reports of 20 new cases. Surg Gynecol Obstet. 1956;102:1–38.
O’Riordan BG VM, Herrera L. Small bowel tumors: an overview. Dig Dis. 1996;14:245–57.
DeSesso JM, Jacobson CF. Anatomical and physiological parameters affecting gastrointestinal absorption in humans and rats. Food Chem Toxicol. 2001;39:209–28.
Edge SB, Byrd DR, Compton CC, et al. AJCC cancer staging manual. 7th ed. New York: Springer; 2010.
Overman MJ, Hu CY, Wolff RA, Chang GJ. Prognostic value of lymph node evaluation in small bowel adenocarcinoma: analysis of the Surveillance, Epidemiology, and End Results database. Cancer. 2010;116:5374–82.
Mandel JS, Church TR, Ederer F, Bond JH. Colorectal cancer mortality: effectiveness of biennial screening for fecal occult blood. J Natl Cancer Inst. 1999;91:434–7.
Winawer SJ, Zauber AG, Ho MN, et al. Prevention of colorectal cancer by colonoscopic polypectomy. The National Polyp Study Workgroup. N Engl J Med. 1993;329:1977–81.
Neugut AI, Jacobson JS, Suh S, et al. The epidemiology of cancer of the small bowel. Cancer Epidemiol Biomarkers Prev. 1998;7:243–51.
Scélo G, Boffetta P, Hemminki K, et al. Associations between small intestine cancer and other primary cancers: an international population-based study. Int J Cancer. 2006;118:189–96.
Chen CC, Neugut AI, Rotterdam H. Risk factors for adenocarcinomas and malignant carcinoids of the small intestine: preliminary findings. Cancer Epidemiol Biomarkers Prev. 1994;3:205–7.
Wu AH, Yu MC, Mack TM. Smoking, alcohol use, dietary factors and risk of small intestinal adenocarcinoma. Int J Cancer. 1997;70:512–7.
Lowenfels AB, Sonni A. Distribution of small bowel tumors. Cancer Lett. 1977;3:83–6.
Kaerlev L, Teglbjaerg PS, Sabroe S, et al. Is there an association between alcohol intake or smoking and small bowel adenocarcinoma? Results from a European multi-center case-control study. Cancer Causes Control. 2000;11:791–7.
Chang GJ, Rodriguez-Bigas MA, Skibber JM, Moyer VA. Lymph node evaluation and survival after curative resection of colon cancer: systematic review. J Natl Cancer Inst. 2007;99:433–41.
Herr HW, Faulkner JR, Grossman HB, et al. Surgical factors influence bladder cancer outcomes: a cooperative group report. J Clin Oncol. 2004;22:2781–9.
Petrik DW, McCready DR, Sawka CA, Goel V. Association between extent of axillary lymph node dissection and patient, tumor, surgeon, and hospital factors in patients with early breast cancer. J Surg Oncol. 2003;82:84–90.
Nicholl MB, Ahuja V, Conway WC, et al. Small bowel adenocarcinoma: understaged and undertreated? Ann Surg Oncol. 2010;17:2728–32.
Howlader N, Ries LA, Mariotto AB, et al. Improved estimates of cancer-specific survival rates from population-based data. J Natl Cancer Inst. 2010;102:1584–98.
Lund JL, Harlan LC, Yabroff KR, Warren JL. Should cause of death from the death certificate be used to examine cancer-specific survival? A study of patients with distant stage disease. Cancer Invest. 2010;28:758–64.
Acknowledgment
This study was supported by the Kavanagh Family Foundation (M.J.O.), American Society of Clinical Oncology Foundation Career Development Award (G.J.C.), and the National Cancer Institute K07-CA133187 (G.J.C.)
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Overman, M.J., Hu, CY., Kopetz, S. et al. A Population-Based Comparison of Adenocarcinoma of the Large and Small Intestine: Insights Into a Rare Disease. Ann Surg Oncol 19, 1439–1445 (2012). https://doi.org/10.1245/s10434-011-2173-6
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DOI: https://doi.org/10.1245/s10434-011-2173-6