Prognostic Factors and Clinical Characteristics of Patients with Primary Duodenal Adenocarcinoma: A Single-Center Experience from China

Abstract

Aim. To evaluate the clinical risk factors influencing overall survival of patients with duodenal adenocarcinoma after potentially curative resection. Methods. A series of 201 patients with primary duodenal adenocarcinoma who underwent surgery from 1999 to 2014 at Chinese Medical Academic Cancer Hospital were studied by retrospective chart review and subsequent telephone follow-up. Results. Resectional surgery was performed in 138 of the 201 patients to attempt curative treatment, while 63 patients were treated with palliative surgery. Median survival of patients who underwent resectional operation was 57 months, whereas that of patients who had palliative surgery was shorter, 7 months (p < 0.001). For patients who underwent radical resection, the overall 1-, 3-, and 5-year survival rates were 87.3, 59.1, and 44.1%, respectively. Multivariate Cox regression analysis revealed that lymph node metastasis (HR 31.76, 2.14 to 470.8; p = 0.012) and vascular invasion (HR 3.75, 1.24 to 11.38; p = 0.020) were independent prognostic factors negatively associated with survival in patients undergoing curative resection. There was no survival difference between the groups treated by the pancreaticoduodenectomy (n = 20) and limited resection (n = 10) for early-stage duodenal adenocarcinoma (p = 0.704). Conclusions. Duodenal adenocarcinoma is a rare disease. Curative resection is the best treatment for appropriate patients. Lymph node metastases and vascular invasion are negative prognostic factors.

Figure 1

Overall survival after potentially curative resection compared with a palliative surgical procedure: the overall 1-, 3-, and 5-year survival rates were 87.3, 59.1, and 44.1% for patients who underwent resection operation, while being 12.8%, 2.2%, and 0 for palliation group. The median survival was 57 months versus 7 months. p < 0.001.

Figure 2

(a) Kaplan–Meyer survival curves comparing patients within the curative resection group by nodal status; (b) Kaplan–Meyer survival curves comparing patients within the curative resection group by vascular invasion.

Figure 3

Kaplan–Meier survival curves for stage I patients undergoing Whipple procedure and segmental resection. p = 0.704.