Duodenal adenocarcinoma: Clinicopathologic analysis and implications for treatment

George A. Poultsides, Lyen C. Huang, John L. Cameron, Richard Tuli, Leslie Lan, Ralph H. Hruban, Timothy M. Pawlik, Joseph M. Herman, Barish H. Edil, Nita Ahuja, Michael A. Choti, Christopher L. Wolfgang, Richard D. Schulick

Research output: Contribution to journalArticle

62 Citations (Scopus)

Abstract

Background. Duodenal adenocarcinoma is a rare cancer usually studied as a group with periampullary or small bowel adenocarcinoma; therefore, its natural history is poorly understood. Methods. Patients with duodenal adenocarcinoma were identified from a single-institution pancreaticoduodenectomy database. Patients with adenocarcinoma arising from the ampulla of Vater were excluded. Univariate and multivariate analyses were performed to identify clinicopathologic variables associated with survival and recurrence after resection. Results. From 1984 to 2006, a total of 122 patients with duodenal adenocarcinoma underwent pancreaticoduodenectomy. Overall survival after resection was 48% at 5 years and 41% at 10 years. Five-year survival decreased as the number of lymph nodes involved by metastasis increased from 0 to 1-3 to ≥4 (68%, 58%, 17%, respectively, P<0.01) and as the lymph node ratio increased from 0 to [0-0.2 to [0.2-0.4 to [0.4 (68%, 57%, 14%, 14%, respectively, P<0.01). Lymph node metastasis was the only independent predictor of decreased survival in multivariate analysis. Recurrence after resection was predominantly distant (81%). Adjuvant chemoradiation did not decrease local recurrence or prolong overall survival; however, patients who received chemoradiation more commonly had nodal metastasis (P = 0.03). Conclusions. The prognostic significance of both the absolute number and ratio of involved lymph nodes emphasizes the need for adequate lymphadenectomy to accurately stage duodenal adenocarcinoma. The mostly distant pattern of recurrence underscores the need for the development of effective systemic therapies.

Original languageEnglish (US)
Pages (from-to)1928-1935
Number of pages8
JournalAnnals of Surgical Oncology
Volume19
Issue number6
DOIs
StatePublished - Jun 2012

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Adenocarcinoma
Lymph Nodes
Survival
Recurrence
Pancreaticoduodenectomy
Neoplasm Metastasis
Therapeutics
Multivariate Analysis
Ampulla of Vater
Lymph Node Excision
Natural History
Databases
Neoplasms

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

Poultsides, G. A., Huang, L. C., Cameron, J. L., Tuli, R., Lan, L., Hruban, R. H., ... Schulick, R. D. (2012). Duodenal adenocarcinoma: Clinicopathologic analysis and implications for treatment. Annals of Surgical Oncology, 19(6), 1928-1935. https://doi.org/10.1245/s10434-011-2168-3

Duodenal adenocarcinoma : Clinicopathologic analysis and implications for treatment. / Poultsides, George A.; Huang, Lyen C.; Cameron, John L.; Tuli, Richard; Lan, Leslie; Hruban, Ralph H.; Pawlik, Timothy M.; Herman, Joseph M.; Edil, Barish H.; Ahuja, Nita; Choti, Michael A.; Wolfgang, Christopher L.; Schulick, Richard D.

In: Annals of Surgical Oncology, Vol. 19, No. 6, 06.2012, p. 1928-1935.

Research output: Contribution to journalArticle

Poultsides, GA, Huang, LC, Cameron, JL, Tuli, R, Lan, L, Hruban, RH, Pawlik, TM, Herman, JM, Edil, BH, Ahuja, N, Choti, MA, Wolfgang, CL & Schulick, RD 2012, 'Duodenal adenocarcinoma: Clinicopathologic analysis and implications for treatment', Annals of Surgical Oncology, vol. 19, no. 6, pp. 1928-1935. https://doi.org/10.1245/s10434-011-2168-3
Poultsides, George A. ; Huang, Lyen C. ; Cameron, John L. ; Tuli, Richard ; Lan, Leslie ; Hruban, Ralph H. ; Pawlik, Timothy M. ; Herman, Joseph M. ; Edil, Barish H. ; Ahuja, Nita ; Choti, Michael A. ; Wolfgang, Christopher L. ; Schulick, Richard D. / Duodenal adenocarcinoma : Clinicopathologic analysis and implications for treatment. In: Annals of Surgical Oncology. 2012 ; Vol. 19, No. 6. pp. 1928-1935.
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abstract = "Background. Duodenal adenocarcinoma is a rare cancer usually studied as a group with periampullary or small bowel adenocarcinoma; therefore, its natural history is poorly understood. Methods. Patients with duodenal adenocarcinoma were identified from a single-institution pancreaticoduodenectomy database. Patients with adenocarcinoma arising from the ampulla of Vater were excluded. Univariate and multivariate analyses were performed to identify clinicopathologic variables associated with survival and recurrence after resection. Results. From 1984 to 2006, a total of 122 patients with duodenal adenocarcinoma underwent pancreaticoduodenectomy. Overall survival after resection was 48{\%} at 5 years and 41{\%} at 10 years. Five-year survival decreased as the number of lymph nodes involved by metastasis increased from 0 to 1-3 to ≥4 (68{\%}, 58{\%}, 17{\%}, respectively, P<0.01) and as the lymph node ratio increased from 0 to [0-0.2 to [0.2-0.4 to [0.4 (68{\%}, 57{\%}, 14{\%}, 14{\%}, respectively, P<0.01). Lymph node metastasis was the only independent predictor of decreased survival in multivariate analysis. Recurrence after resection was predominantly distant (81{\%}). Adjuvant chemoradiation did not decrease local recurrence or prolong overall survival; however, patients who received chemoradiation more commonly had nodal metastasis (P = 0.03). Conclusions. The prognostic significance of both the absolute number and ratio of involved lymph nodes emphasizes the need for adequate lymphadenectomy to accurately stage duodenal adenocarcinoma. The mostly distant pattern of recurrence underscores the need for the development of effective systemic therapies.",
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AU - Cameron, John L.

AU - Tuli, Richard

AU - Lan, Leslie

AU - Hruban, Ralph H.

AU - Pawlik, Timothy M.

AU - Herman, Joseph M.

AU - Edil, Barish H.

AU - Ahuja, Nita

AU - Choti, Michael A.

AU - Wolfgang, Christopher L.

AU - Schulick, Richard D.

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N2 - Background. Duodenal adenocarcinoma is a rare cancer usually studied as a group with periampullary or small bowel adenocarcinoma; therefore, its natural history is poorly understood. Methods. Patients with duodenal adenocarcinoma were identified from a single-institution pancreaticoduodenectomy database. Patients with adenocarcinoma arising from the ampulla of Vater were excluded. Univariate and multivariate analyses were performed to identify clinicopathologic variables associated with survival and recurrence after resection. Results. From 1984 to 2006, a total of 122 patients with duodenal adenocarcinoma underwent pancreaticoduodenectomy. Overall survival after resection was 48% at 5 years and 41% at 10 years. Five-year survival decreased as the number of lymph nodes involved by metastasis increased from 0 to 1-3 to ≥4 (68%, 58%, 17%, respectively, P<0.01) and as the lymph node ratio increased from 0 to [0-0.2 to [0.2-0.4 to [0.4 (68%, 57%, 14%, 14%, respectively, P<0.01). Lymph node metastasis was the only independent predictor of decreased survival in multivariate analysis. Recurrence after resection was predominantly distant (81%). Adjuvant chemoradiation did not decrease local recurrence or prolong overall survival; however, patients who received chemoradiation more commonly had nodal metastasis (P = 0.03). Conclusions. The prognostic significance of both the absolute number and ratio of involved lymph nodes emphasizes the need for adequate lymphadenectomy to accurately stage duodenal adenocarcinoma. The mostly distant pattern of recurrence underscores the need for the development of effective systemic therapies.

AB - Background. Duodenal adenocarcinoma is a rare cancer usually studied as a group with periampullary or small bowel adenocarcinoma; therefore, its natural history is poorly understood. Methods. Patients with duodenal adenocarcinoma were identified from a single-institution pancreaticoduodenectomy database. Patients with adenocarcinoma arising from the ampulla of Vater were excluded. Univariate and multivariate analyses were performed to identify clinicopathologic variables associated with survival and recurrence after resection. Results. From 1984 to 2006, a total of 122 patients with duodenal adenocarcinoma underwent pancreaticoduodenectomy. Overall survival after resection was 48% at 5 years and 41% at 10 years. Five-year survival decreased as the number of lymph nodes involved by metastasis increased from 0 to 1-3 to ≥4 (68%, 58%, 17%, respectively, P<0.01) and as the lymph node ratio increased from 0 to [0-0.2 to [0.2-0.4 to [0.4 (68%, 57%, 14%, 14%, respectively, P<0.01). Lymph node metastasis was the only independent predictor of decreased survival in multivariate analysis. Recurrence after resection was predominantly distant (81%). Adjuvant chemoradiation did not decrease local recurrence or prolong overall survival; however, patients who received chemoradiation more commonly had nodal metastasis (P = 0.03). Conclusions. The prognostic significance of both the absolute number and ratio of involved lymph nodes emphasizes the need for adequate lymphadenectomy to accurately stage duodenal adenocarcinoma. The mostly distant pattern of recurrence underscores the need for the development of effective systemic therapies.

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