Adenocarcinoma of the small intestine: A multi-institutional study of 197 surgically resected cases

Hee Kyung Chang, Eunsil Yu, Jihun Kim, Young Kyung Bae, Kee Taek Jang, Eun Sun Jung, Ghil Suk Yoon, Joon Mee Kim, Young Ha Oh, Han Ik Bae, Gwang Il Kim, Soo Jin Jung, Mi Jin Gu, Jung Yeon Kim, Kyu Yun Jang, Sun Young Jun, Dae Woon Eom, Kye Won Kwon, Gyeong Hoon Kang, Jae Bok ParkSoonwon Hong, Ji Shin Lee, Jason Y. Park, Seung Mo Hong

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Abstract

Small intestinal adenocarcinoma is a rare malignant neoplasm, and its clinicopathologic characteristics have not been well elucidated. A total of 197 small intestinal adenocarcinoma cases were collected from 22 institutions in South Korea and were evaluated for clinicopathologic factors that affect the prognosis of small intestinal adenocarcinoma patients using univariate and multivariate analyses. The mean patient age was 59 years, and the male-to-female ratio was 1.7:1. Tumors were located in the duodenum of 108 cases (55%), the jejunum in 59 (30%), and the ileum in 30 (15%). Predisposing conditions were observed in 23 cases (12%), including 17 cases with sporadic adenomas, 3 with Peutz-Jeghers syndrome, 2 with Meckel diverticulum, and 1 with Crohn disease. Synchronous or metachronous malignant tumors were identified in 31 cases (16%), including 13 colorectal and 10 stomach cancers. About 90% of tumors were classified as either pT3 (63 cases) or pT4 (112 cases). The median survival time for all small intestinal adenocarcinoma patients was 39.7 months. Compared with small intestinal adenocarcinomas without accompanying sporadic adenomas, small intestinal adenocarcinomas with accompanying adenomas were more well differentiated (P < .0001), with a more polypoid growth pattern (P < .0001), a lower pT classification (P < .0001), less perineural invasion (P = .01), and less lymphatic invasion (P = .03). Small intestinal adenocarcinoma patients with associated sporadic adenomas (77%) had a significantly better 5-year survival rate than those without sporadic adenomas (38%, P = .02). By univariate analysis, small intestinal adenocarcinoma patients had significantly different survival based on pT classification (P = .003), lymph node metastasis (P < .0001), distal location (jejunal and ileal carcinomas) (P = .003), retroperitoneal tumor seeding (P < .0001), vascular invasion (P = .007), lymphatic invasion (P = .001), peritumoral dysplasia (P = .004), and radiation therapy (P = .006). By multivariate analysis, lymph node metastasis (P = .01) and distal location (P = .003) were independent predictors of a worse prognosis. In conclusion, (1) small intestinal adenocarcinomas are diagnosed at an advanced disease stage; therefore, the development of strategies for detection at an earlier stage is needed. (2) Small intestinal adenocarcinoma patients with an adenomatous component had a better survival than those without an adenomatous component. (3) Lymph node metastasis and distal location (jejunum and ileum) of tumor are the most important independent prognostic factors.

Original languageEnglish (US)
Pages (from-to)1087-1096
Number of pages10
JournalHuman Pathology
Volume41
Issue number8
DOIs
StatePublished - Aug 2010

Keywords

  • Adenocarcinoma
  • Adenoma
  • Prognosis
  • Small intestine
  • Survival

ASJC Scopus subject areas

  • Pathology and Forensic Medicine

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    Chang, H. K., Yu, E., Kim, J., Bae, Y. K., Jang, K. T., Jung, E. S., Yoon, G. S., Kim, J. M., Oh, Y. H., Bae, H. I., Kim, G. I., Jung, S. J., Gu, M. J., Kim, J. Y., Jang, K. Y., Jun, S. Y., Eom, D. W., Kwon, K. W., Kang, G. H., ... Hong, S. M. (2010). Adenocarcinoma of the small intestine: A multi-institutional study of 197 surgically resected cases. Human Pathology, 41(8), 1087-1096. https://doi.org/10.1016/j.humpath.2010.01.006