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Comparative Study
. 2012 May;19(5):1439-45.
doi: 10.1245/s10434-011-2173-6. Epub 2011 Dec 21.

A population-based comparison of adenocarcinoma of the large and small intestine: insights into a rare disease

Michael J Overman  1 , Chung-Yuan Hu, Scott Kopetz, James L Abbruzzese, Robert A Wolff, George J Chang
Affiliations
Comparative Study

A population-based comparison of adenocarcinoma of the large and small intestine: insights into a rare disease

Michael J Overman et al. Ann Surg Oncol. 2012 May.

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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Conflict of interest statement

Conflicts of Interest: none

Figures

FIGURE 1
FIGURE 1
Age-standardized incidence rates for adenocarcinoma of the (a) large and (b) small intestine. Abbreviations: SBA, small bowel adenocarcinoma; LBA, large bowel adenocarcinoma; APC, annual percentage change
FIGURE 1
FIGURE 1
Age-standardized incidence rates for adenocarcinoma of the (a) large and (b) small intestine. Abbreviations: SBA, small bowel adenocarcinoma; LBA, large bowel adenocarcinoma; APC, annual percentage change
FIGURE 2
FIGURE 2
Age-standardized mortality rates for adenocarcinoma of the (a) large and (b) small intestine. Abbreviations: SBA, small bowel adenocarcinoma; LBA, large bowel adenocarcinoma; APC, annual percentage change
FIGURE 2
FIGURE 2
Age-standardized mortality rates for adenocarcinoma of the (a) large and (b) small intestine. Abbreviations: SBA, small bowel adenocarcinoma; LBA, large bowel adenocarcinoma; APC, annual percentage change
FIGURE 3
FIGURE 3
Stage stratified cancer specific survival for adenocarcinoma of the large and small intestine: (a) all patients and (b) patients with ≥ 8 lymph nodes examined. Abbreviations: SBA, small bowel adenocarcinoma; LBA, large bowel adenocarcinoma.
FIGURE 3
FIGURE 3
Stage stratified cancer specific survival for adenocarcinoma of the large and small intestine: (a) all patients and (b) patients with ≥ 8 lymph nodes examined. Abbreviations: SBA, small bowel adenocarcinoma; LBA, large bowel adenocarcinoma.
FIGURE 4
FIGURE 4
(a) The relative reduction in cancer specific mortality with the selection of cases with ≥ 8 lymph nodes assessed and (b) the absolute difference in CSS between SBA and LBA for cases with ≥ 8 lymph nodes assessed. Abbreviations: SBA, small bowel adenocarcinoma; LBA, large bowel adenocarcinoma; CSS, cancer specific survival.
FIGURE 4
FIGURE 4
(a) The relative reduction in cancer specific mortality with the selection of cases with ≥ 8 lymph nodes assessed and (b) the absolute difference in CSS between SBA and LBA for cases with ≥ 8 lymph nodes assessed. Abbreviations: SBA, small bowel adenocarcinoma; LBA, large bowel adenocarcinoma; CSS, cancer specific survival.
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