LONG-TERM PROGNOSIS AND RECURRENCE RISK IN RESECTED NON-DUODENAL SMALL BOWEL ADENOCARCINOMA: A POST-HOC MULTICENTER STUDY
Toshio Kuwai1, Yuki Kamigaichi1, Shiro Oka1, Takeshi Yamada2, Keigo Mitsui2, Hironori Yamamoto3, Keiichi Takahashi4, Akio Shiomi5, Kinichi Hotta5, Yoji Takauchi6, Fumio Ishida7, Shin-ei Kudo7, Shoichi Saito8, Masashi Ueno9, Eiji Sunami10, Tomoki Yamano11, Michio Itabashi12, Kazuo Ohtsuka13, Yusuke Kinugasa13, Takayuki Matsumoto14, Tamotsu Sugai14, Toshio Uraoka15, Koichi Kurahara16, Shigeki Yamaguchi17, Tomohiro Kato18, Masazumi Okajima19, Hiroshi Kashida20, Hiroaki Ikematsu21, Masaaki Ito21, Motohiro Esaki22, Masaya Kawai23, Takashi Yao24, Takahiro Horimatsu25, Yasumori Fukai26, Yukihide Kanemitsu27, Hiroyuki Takamaru27, Kazutaka Yamada28, Hiroaki Nozawa29, Tetsuji Takayama30, Kazutomo Togashi31, Eiji Shinto32, Takehiro Torisu33, Naoki Ohmiya34, Eigo Otsuji36, Shinji Nagata37, Yojiro Hashiguchi38, Kenichi Sugihara39, Yoichi Ajioka40, Shinji Tanaka351. Hiroshima Daigaku Byoin, Hiroshima, Hiroshima, Japan.
2. Nihon Ika Daigaku, Bunkyo, Tokyo, Japan.
3. Jichi Ika Daigaku, Shimotsuke, Tochigi Prefecture, Japan.
4. Grace Home Care Clinic, Ito, Shizuoka, Japan.
5. Shizuoka Kenritsu Shizuoka Gan Center, Sunto District, Shizuoka Prefecture, Japan.
6. Osaka Kokusai Gan Center, Osaka, Osaka Prefecture, Japan.
7. Showa Medical University Northern Yokohama Hospital, Kanagawa, Japan.
8. Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan.
9. Toranomon Byoin, Minato, Tokyo, Japan.
10. Kyorin University School of Medicine, Tokyo, Japan.
11. Hyogo Ika Daigaku, Nishinomiya, Hyogo Prefecture, Japan.
12. Tokyo Women’s Medical University, Tokyo, Japan.
13. Tokyo Kagaku Daigaku, Meguro, Tokyo, Japan.
14. Iwate Ika Daigaku, Shiwa District, Iwate Prefecture, Japan.
15. Gunma Daigaku Daigakuin Igakukei Kenkyuka Igakubu, Maebashi, Gunma Prefecture, Japan.
16. Matsuyama Sekijuji Byoin, Matsuyama, Ehime Prefecture, Japan.
17. Saitama Ika Daigaku Kokusai Iryo Center, Hidaka, Saitama Prefecture, Japan.
18. Tokyo Jikeikai Ika Daigaku, Minato, Tokyo, Japan.
19. Hiroshima Shiritsu Hiroshima Shimin Byoin, Hiroshima, Hiroshima Prefecture, Japan.
20. Kinki Daigaku Byoin, Osakasayama, Osaka Prefecture, Japan.
21. National Cancer Center Hospital East, Chiba, Japan.
22. Saga Daigaku, Saga, Saga Prefecture, Japan.
23. Juntendo Daigaku, Bunkyo, Tokyo, Japan.
24. Juntendo University Graduate School of Medicine, Tokyo, Japan.
25. Kyoto Daigaku Igakubu Fuzoku Byoin, Kyoto, Kyoto Prefecture, Japan.
26. Maebashi Sekijuji Byoin, Maebashi, Gunma Prefecture, Japan.
27. National Cancer Center, Goyang-si, Gyeonggi-do, Korea (the Republic of).
28. Daicho Komonbyo Center Takano Byoin, Kumamoto, Kumamoto Prefecture, Japan.
29. Tokyo Daigaku, Bunkyo, Tokyo, Japan.
30. Tokushima Daigaku Daigakuin Ishiyakugaku Kenkyubu, Tokushima, Tokushima Prefecture, Japan.
31. Fukushima Kenritsu Ika Daigaku Aizu Iryo Center, Aizuwakamatsu, Fukushima Prefecture, Japan.
32. Boei Ika Daigakko, Tokorozawa, Saitama Prefecture, Japan.
33. Kyushu Daigaku, Fukuoka, Fukuoka Prefecture, Japan.
34. Fujita Ika Daigaku Igakubu Daigakuin Igaku Kenkyuka, Toyoake, Aichi Prefecture, Japan.
35. JA Onomichi Sogo Byoin, Onomichi, Hiroshima Prefecture, Japan.
36. Kyoto Furitsu Ika Daigaku, Kyoto, Kyoto Prefecture, Japan.
37. Hiroshima Shiritsu Asa Shimin Byoin, Hiroshima, Hiroshima Prefecture, Japan.
38. Japanese Red Cross Omori Hospital, Tokyo, Japan.
39. Tokyo Kagaku Daigaku, Meguro, Tokyo, Japan.
40. Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
Background and Aims: Despite advances in diagnostic techniques that have improved the detection of non-duodenal small bowel adenocarcinoma (NDSBA), long-term outcome data are limited by rarity. Most existing studies include duodenal cancers, which may have distinct biological behaviors, leading to a knowledge gap. This valuable large-scale study focuses exclusively on the prognosis of resectable NDSBA, aiming to evaluate long-term outcomes, including recurrence and risk factors, in patients who underwent surgical resection for clinical stage Iâ€"III NDSBA.
Methods: This multicenter retrospective study analyzed 171 patients who underwent surgical resection for stage Iâ€"III NDSBA at 44 Japanese institutions. The main objective was the recurrence rate, assessed by the cumulative incidence of recurrence (CIR). Survival outcomes were estimated using the Kaplan-Meier method, and a Fine-Gray competing risk model was used to identify independent risk factors for recurrence.
Results: Clinical stages I, II, and III accounted for 3.5% (6/171), 51.5% (88/171), and 45.0% (77/171) of cases, respectively. The stage-specific recurrence rates were 16.7% (1/6) for Stage I, 20.5% (18/88) for Stage II, and 36.4% (28/77) for Stage III. Five-year overall survival, relapse-free survival, and disease-specific survival rates were 71.0%, 61.4%, and 75.9%, respectively. The 5-year CIR was 32.7%. Multivariate analysis identified lymph node metastasis, T4 stage, adjuvant therapy use, macroscopic type 1, and tumor size <50 mm as independent risk factors for the CIR. Most recurrences (93.6%) occurred within 3 years post-surgery.
Conclusion: NDSBA demonstrates relatively favorable survival outcomes, with most recurrences appearing within the first three years. Postoperative surveillance should last at least 3-5 years, particularly for patients with identified risk factors.
Cumulative incidence of recurrence (CIR)A: 5-year CIR for all cases, B: 5-year CIR according to tumor location
Univariable and Multivariable analysis for cumulative incidence of recurrenceIMAGE CAPTION: Cumulative incidence of recurrence (CIR)
A: 5-year CIR for all cases, B: 5-year CIR according to tumor location
Univariable and Multivariable analysis for cumulative incidence of recurrence
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