Korean J Gastroenterol.  2015 Oct;66(4):194-201. 10.4166/kjg.2015.66.4.194.

Primary Non-ampullary Duodenal Adenocarcinoma: A Single-center Experience for 15 Years

• You HS
• Hong JW
• Yun EY
• Kim JJ
• Lee JM
• Lee SS
• Kim HJ
• Ha CY
• Kim HJ
• Kim TH
• Jung WT
• Lee OJ

• KMID: 2373341
• DOI: http://doi.org/10.4166/kjg.2015.66.4.194

Abstract

BACKGROUND/AIMS
Primary non-ampullary duodenal adenocarcinomas (PNADAs) comprise <0.3% of gastrointestinal malignancies. The rarity of PNADA and poorly defined natural history often leads to a delayed correct diagnosis. This study was conducted to evaluate the clinical characteristics of PNADA and to identify its prognostic factors.
METHODS
Data were collected by retrospectively reviewing the medical records of patients with PNADA managed at Gyeongsang National University Hospital from January 2000 to December 2014. Demographic, clinical, endoscopic, and pathological variables were investigated, and factors related to survival were analyzed.
RESULTS
Twenty-seven patients with PNADA were identified, and their median age was 64.9+/-13.6 years with 16 (59.3%) being male. The majority of patients (25/27, 92.6%) were initially diagnosed during upper endoscopy with biopsies. The tumor was located on the 1st or 2nd portion of duodenum in 92.6% (25/27) of patients. At the time of diagnosis, 85.2% (23/27) had advanced diseases (stage III or IV); 48.2% (13/27) had distant metastasis. Median survival time was 12 months (1-93 months). One and 3-year survival rates were 48.1% and 33.3%, respectively. On multivariable analysis, total bilirubin > or =2 mg/dL (OR, 85.28; 95% CI, 3.77-1,938.79; p=0.005) and distant metastasis (OR, 26.74; 95% CI, 3.13-2,328.14; p=0.003) at the time of diagnosis were independent poor prognostic factors.
CONCLUSIONS
The majority of patients were diagnosed at an advanced stage. Presence of distant metastasis was independent prognostic factor of PNADA together with elevated total bilirubin.

Keyword

Dudenal cancer; Adenocarcinoma; Survival; Prognosis

MeSH Terms

Adenocarcinoma/*diagnosis/mortality/pathology
Adult
Aged
Aged, 80 and over
Bilirubin/blood
Demography
Duodenal Neoplasms/*diagnosis/mortality/pathology
Female
Gastroscopy
Humans
Kaplan-Meier Estimate
Male
Middle Aged
Neoplasm Metastasis
Neoplasm Recurrence, Local
Neoplasm Staging
Prognosis
Retrospective Studies
Bilirubin

Figure

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  Fig. 1. Overall survival curve in patients with primary non-ampullary duodenal adenocarcinoma. Overall one-year and 3-year survival rates were 48.1% and 33.3%, respectively in 27 patients with primary non-ampullary duodenal adenocacinoma.

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  Fig. 2. Cumulative survival curves in the patients with primary non-ampullary duodenal adenocarcinoma according to total bilirubin and M stage.(A) Survival rate is higher in patients with total bilirubin <2 mg/dL than those with ≥2 mg/dL (p=0.003). (B) Survival rate is higher in M1 than M0 stage (p=0.000).

Reference

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