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Multicenter Study
. 2023 Aug 31;7(5):pkad064.
doi: 10.1093/jncics/pkad064.

Adjuvant chemotherapy benefit according to T and N stage in small bowel adenocarcinoma: a large retrospective multicenter study

Aziz Zaanan  1 , Julie Henriques  2   3 , Anthony Turpin  4 , Sylvain Manfredi  5 , Romain Coriat  6 , Eric Terrebonne  7 , Jean-Louis Legoux  8 , Thomas Walter  9 , Christophe Locher  10 , Olivier Dubreuil  11 , Simon Pernot  12 , Chloé Vernet  13 , Olivier Bouché  14 , Vincent Hautefeuille  15 , Johan Gagniere  16 , Thierry Lecomte  17 , David Tougeron  18 , Thomas Grainville  19 , Dewi Vernerey  2   3 , Pauline Afchain  20 , Thomas Aparicio  21
Affiliations
Multicenter Study

Adjuvant chemotherapy benefit according to T and N stage in small bowel adenocarcinoma: a large retrospective multicenter study

Aziz Zaanan et al. JNCI Cancer Spectr. .

Abstract

Background: Small bowel adenocarcinoma is a rare cancer, and the role of adjuvant chemotherapy for localized disease is still debated.

Methods: This retrospective multicenter study included all consecutive patients who underwent curative surgical resection for localized small bowel adenocarcinoma between 1996 and 2019 from 3 French cohort studies. Prognostic and predictive factors of adjuvant chemotherapy efficacy were analyzed for disease-free survival and overall survival. The inverse probability of treatment weighting method was applied in the Cox regression model using the propensity score derived from multivariable logistic regression.

Results: A total of 354 patients were included: median age, 63.5 years; duodenum location, 53.5%; and tumor stage I, II, and III in 31 (8.7%), 144 (40.7%), and 179 (50.6%) patients, respectively. The adjuvant chemotherapy was administered in 0 (0%), 66 (48.5%), and 143 (80.3%) patients with stage I, II, and III, respectively (P < .0001). In the subgroup analysis by inverse probability of treatment weighting method, a statistically significant disease-free survival and overall survival benefit in favor of adjuvant chemotherapy was observed in high-risk stage II (T4 and/or <8 lymph nodes examined) and III (T4 and/or N2) but not for low-risk stage II (T3 and ≥8 lymph nodes examined) and III (T1-3/N1) tumors (Pinteraction < .05). Furthermore, tumor location in jejunum and ileum was also a statistically significant predictive factor of response to adjuvant chemotherapy in stage II and III tumors (Pinteraction < .05).

Conclusion: In localized small bowel adenocarcinoma, adjuvant chemotherapy seems to provide a statistically significant survival benefit for high-risk stage II and III tumors and for jejunum and ileum tumor locations.

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Conflict of interest statement

AZ has participated in consulting and/or advisory boards for Amgen, Astellas, Lilly, Merck, Roche, Sanofi, Servier, Baxter, MSD, BMS, Pierre Fabre, Havas Life, Alira Health, Zymeworks, Daiichi Sankyo, Astra Zeneca.

AT has participated in consulting and/or advisory boards for Merck, Servier, Viatris, Pierre Fabre and Astra Zeneca.

SM has participated in consulting and/or advisory boards for Amgen, Astra Zeneca, Sanofi, Servier, BMS.

JLL has participated in consulting board for Servier, received a research support from Sanofi to FFCD.

TW has participated in consulting and/or advisory boards for IPSEN, Novartis-AAA, Esteve, MSD, BMS, Pierre Fabre, Terumo, Sirtex.

CL has participated in consulting and/or advisory boards for Astra Zeneca.

OD has participated in consulting and/or advisory boards for Amgen, Merck-Serono, Pierre Fabre, Sanofi, Servier, MSD, BMS.

SP has participated in consulting and/or advisory board for Amgen, Servier, Merck-Serono, Pierre Fabre, Servier, MSD, BMS, Astrazeneca.

OB has participated in consulting and/or advisory boards for Amgen, Apmonia Therapeutics, Astellas, Deciphera, Merck, Servier, Baxter, MSD, Pierre Fabre.

VH has participated in consulting and/or advisory boards for Amgen, Merck, Servier, MSD, Pierre Fabre, AAA, Ipsen, Deciphera.

TL has participated in consulting and/or advisory boards for Sanofi, Merck Serono, Servier, Amgen, IPSEN, BMS, Pierre Fabre, Astra Zeneca.

DT has participated in consulting and/or advisory boards for Amgen, Roche, Servier, MSD, BMS, Pierre Fabre, Astra Zeneca, and Bayer.

PA has participated in consulting and/or advisory boards for Ipsen.

TA has participated in consulting and/or advisory boards for Pierre Fabre, Amgen, SIRTEC, MSD, Servier and BMS.

All other authors declare no conflict of interest.

Figures

Figure 1.
Figure 1.
Flow chart.
Figure 2.
Figure 2.
Forest plot for disease-free survival (A) and overall survival (B) in stage II population by the inverse probability of treatment weighting method. High-risk group: pT4 or less than 8 lymph nodes examined; low-risk group: pT3 and 8 or more lymph nodes examined; lower confidence interval and upper confidence interval: 90%. The inverse probability of treatment weighting method was applied in the Cox regression model using the propensity score derived from multivariable logistic regression to assess the association between adjuvant chemotherapy and survival. Two variables were not tested in this model because of the very unbalanced distribution: perforation (yes vs no: 5 vs 102) and differentiation (low vs well or moderate: 14 vs 102). CI = confidence interval; HR = hazard ratio; VELIPI = vascular emboli, lymphatic invasion, and perinervous invasion.
Figure 3.
Figure 3.
Forest plot for disease-free survival (A) and overall survival (B) in stage III population by the inverse probability of treatment weighting method. High-risk group: pT4 and/or N2; low-risk group: pT1-3/N1; lower confidence interval and upper confidence interval: 90%. The inverse probability of treatment weighting method was applied in the Cox regression model using the propensity score derived from multivariable logistic regression to assess the association between adjuvant chemotherapy and survival. CI = confidence interval; HR = hazard ratio.
See this image and copyright information in PMC

References

    1. Siegel RL, Miller KD, Jemal A.. Cancer statistics, 2020. CA Cancer J Clin. 2020;70(1):7-30. doi:10.3322/caac.21590 - DOI - PubMed
    1. Pedersen KS, Raghav K, Overman MJ.. Small bowel adenocarcinoma: etiology, presentation, and molecular alterations. J Natl Compr Canc Netw. 2019;17(9):1135-1141. doi:10.6004/jnccn.2019.7344 - DOI - PubMed
    1. Green PHR, Jabri B.. Celiac disease and other precursors to small-bowel malignancy. Gastroenterol Clin North Am. 2002;31(2):625-639. doi:10.1016/s0889-8553(02)00010-9 - DOI - PubMed
    1. Turpin A, El Amrani M, Zaanan A.. Localized small bowel adenocarcinoma management: evidence summary. Cancers (Basel). 2022;14(12):2892. doi:10.3390/cancers14122892 - DOI - PMC - PubMed
    1. Aparicio T, Henriques J, Manfredi S, et al.; NADEGE Investigators. Small bowel adenocarcinoma: Results from a nationwide prospective ARCAD-NADEGE cohort study of 347 patients. Int J Cancer. 2020;147(4):967-977. doi:10.1002/ijc.32860 - DOI - PubMed

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