Analysis Of Clinicopathological Features And Prognostic Factors Of Patients Of The Small Intestine Adenocarcinoma

Objective: Adenocarcinoma of the small intestine is an extremely rare malignancy,accounting for about 3% of gastrointestinal malignancies.Due to the low incidence of small intestine adenocarcinoma and limited clinical data,there are few studies on the treatment and prognostic factors of small intestine adenocarcinoma.This study retrospectively analyzed the clinicopathological features and prognostic factors of 300 patients with adenocarcinoma of the small intestine,to provide clinical help.Methods: A total of 300 patients who underwent surgical treatment in the First Affiliated Hospital of Anhui Medical University,the Second Affiliated Hospital of Anhui Medical University and provincial Hospital from January 2003 to July 2020 were collected.All patients were pathologically diagnosed as adenocarcinoma of small intestine.The clinical and pathological features and prognostic factors of adenocarcinoma of the small intestine were retrospectively analyzed.Kaplan-meier method was used to analyze Overall survival（OS）,and log-rank was used for statistical comparison.COX univariate and multivariate analyses were used to determine the independent factors affecting survival in patients with small intestinal adenocarcinoma.Results: 1)A total of 300 patients with adenocarcinoma were included,including 123females（41.0%）and 177 males（59.0%）,with a high incidence rate in males.Patients with small intestinal adenocarcinoma ranged in age from 26 to 90 years,with a median age of 58.5 years.The primary tumor was on the duodenal papilla in 156 patients（52.0%）,in the non-ampulla duodena in 61 patients（20.3%）,and in the jejunum/ileum in 83 patients（27.7%）.At the time of diagnosis,288 patients（96.0%）presented clinical symptoms,including jaundice in patients with adenocarcinoma of the duodenal papilla and abdominal pain in patients with the non-ampullary duodenal and jejunoileal adenocarcinoma.All patients received surgical treatment,most of which were pancreaticoduodenectomy for duodenal adenocarcinoma and most of which were partial resection of small intestine for jejunoileal adenocarcinoma.In this study,34（21.8%）,78（50.0%）,and 42（26.9%）patients with stage 0/I,II,and III duodenal papillary adenocarcinoma were identified,with 1-year survival rates of 90.9%,82.6%,75.6%,and 33.3%,respectively.2)Log-rank test was used to conduct univariate analysis of the whole group.The factors influencing the survival of patients with small intestinal adenocarcinoma were higher preoperative CEA（≥5ng/m L）,higher preoperative CA199（≥ 34 U /m L）,lower preoperative albumin(< 180 mg,depth of tumor invasion（T3+T4）,lymph node metastasis,distant metastasis,TNM stage IV,higher NLR（≥ 4.51）,and lower LMR（< 2.32）and lower PLR（< 117.58）.Age,gender,preoperative hemoglobin and albumin,chemotherapy and other factors are not important factors affecting prognosis.Multivariate analysis showed that higher preoperative CA199 level,lower preoperative prealbumin concentration,TNM stage IV,higher NLR,and lower PLR were independent prognostic factors for small bowel adenocarcinoma.According to the analysis of duodenum and hollow ileum,there were different prognostic factors affecting the two groups,among which TNM stage IV,nerve invasion,low prealbumin concentration,higher preoperative CA199 level and lower PLR were independent prognostic factors for duodenal adenocarcinoma.The independent prognostic factors for hollow bowel adenocarcinoma were higher preoperative CEA,low LMR,TNM stage IV,and nerve invasion.Conclusion: Adenocarcinoma of the small intestine is difficult to be diagnosed early,the clinical symptoms lack specificity,and it is difficult to distinguish from other digestive tract diseases.Higher preoperative CA199 level,lower preoperative prealbumin concentration,TNM stage IV,higher NLR,and lower PLR were independent prognostic factors for small bowel adenocarcinoma.There are different prognostic factors for duodenal adenocarcinoma and hollow bowel adenocarcinoma,among which TNM stage IV,nerve invasion,lower preoperative prealbumin concentration,higher preoperative CA199 level and lower PLR are independent prognostic factors.The independent prognostic factors for hollow bowel adenocarcinoma were high preoperative CEA,low LMR,TNM stage IV,and nerve invasion.