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CLINICOPATHOLOGICAL CHARACTERISTICS AND PROGNOSIS OF PRIMARY SMALL-BOWEL CANCER: AN ANALYSIS OF THE JSCCR DATABASE FROM MULTICENTER IN JAPAN

Ken Yamashita 1, Shiro Oka 1, Takeshi Yamada 2, Keigo Mitsui 3, Hironori Yamamoto 4, Keiichi Takahashi 5, Akio Shiomi 6, Kinichi Hotta 6, Yoji Takeuchi 7, Toshio Kuwai 8, Fumio Ishida 9, Shinei Kudo 9, Shoichi Saito 10, Masashi Ueno 10, Eiji Sunami　 11, Tomoki Yamano 12, Michio Itabashi 13, Kazuo Ohtsuka 14, Yusuke Kinugasa 14, Takayuki Matsumoto 15, Tamotsu Sugai 15, Toshio Uraoka 16, Koichi Kurahara 17, Shigeki Yamaguchi 18, Tomohiro Kato 19, Masazumi Okajima 20, Hiroshi Kashida 21, Yoshito Akagi 22, Hiroaki Ikematsu 23, Masaaki Ito　 23, Motohiro Esaki　 24, Masaya Kawai　 25, Takashi Yao 26, Yojiro Hashiguchi　 27, Kenichi Sugihara 14, Yoichi Ajioka 28, Shinji Tanaka 1

Affiliations

1 Hiroshima University Hospital, Hiroshima, Japan

2 Nippon Medical School, Tokyo, Japan

3 Nippon Medical School, Graduate School of Medicine, Tokyo, Japan

4 Jichi Medical University, Tochigi, Japan

5 Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan

6 Shizuoka Cancer Center, Shizuoka, Japan

7 Osaka International Cancer Institute, Osaka, Japan

8 National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Hiroshima, Japan

9 Showa University Northern Yokohama Hospital, Kanagawa, Japan

10 Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan

11 Kyorin University School of Medicine, Tokyo, Japan

12 Hyogo College of Medicine, Hyogo, Japan

13 Tokyo Women's Medical University, Tokyo, Japan

14 Tokyo Medical and Dental University, Tokyo, Japan

15 Iwate Medical University, Iwate, Japan

16 Gunma University Graduate School of Medicine, Gunma, Japan

17 Matsuyama Red Cross Hospital, Ehime, Japan

18 Saitama Medical University International Medical Center, Saitama, Japan

19 The Jikei University School of Medicine, Tokyo, Japan

20 Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan

21 Kindai University, Osaka, Japan

22 Kurume University School of Medicine, Fukuoka, Japan

23 National Cancer Center Hospital East, Chiba, Japan

24 Saga University, Saga, Japan

25 Juntendo University, Tokyo, Japan

26 Juntendo University Graduate School of Medicine, Tokyo, Japan

27 Japanese Red Cross Omori Hospital, Tokyo, Japan

28 Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan

Summary

AI Generated

A Japanese multicenter study of 354 patients with primary jejunal and ileal cancer found that 76.8% presented with symptoms and 36.2% had stage IV disease at diagnosis, with 5-year disease-specific survival rates ranging from 100% for stage 0 to 25.6% for stage IV.

The study enrolled 354 patients with 358 primary small-bowel cancers of the jejunum and ileum from 44 Japanese institutions between 2008 and 2017, with average age 64.4 years and 61.6% male.
Most tumors were located in the jejunum (66.2%) versus ileum (30.4%), with average tumor size 49.9 mm; 5.4% of patients had Lynch syndrome.
Stage distribution showed 36.2% presented with stage IV disease, 25.8% stage III, 27.0% stage II, 2.5% stage I, and 5.3% stage 0; peritoneum was the most common metastatic site (55.8%) in stage IV patients.
Jejunal location had significantly lower 5-year disease-specific survival than ileal location (50.8% vs 66.7%, p=0.0418), and symptomatic presentation was associated with worse survival than asymptomatic (51.2% vs 70.5%, p=0.0416).
The authors conclude that early detection before symptom onset and screening of high-risk patients such as those with Lynch syndrome may improve outcomes.

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Abstract

Introduction

Primary small-bowel cancer (PSBC), including duodenum, jejunum and ileum, is a relatively uncommon disease. However, the number of cases has been increasing in recent years. Furthermore, since more than half of all PSBCs occurred in the duodenum, cancers of the jejunum and ileum were particularly rare tumors. Few reports have focused on the jejunum and ileum.

Aims & Methods

We analyzed the clinicopathological features and prognosis of PSBC from a large multicenter study conducted in Japan. A total of 2,388 primary small-bowel lesions were collected between January 2008 and December 2017 from 44 institutions affiliated with the Japanese Society for Cancer of the Colon and Rectum (JSCCR) in Japan. We excluded 2,032 lesions for the following reasons: site of duodenum, unavailability of patient’s or tumor essential information, histology not consistent with PSBC (such as malignant lymphoma, gastrointestinal stromal tumor, metastasis of PSBC, hamartoma, adenoma, or others), and patients with background diseases such as (Crohn disease, familial adenomatous polyposis, and Peutz-Jeghers syndrome). Because it was more difficult to clearly diagnose Lynch syndrome than other diseases, we did not exclud it in this study. We analyzed the clinicopathological features and the prognosis of PSBC. Clinicopathological features and TNM classification were evaluated according to the Japanese Classification of Colorectal, Appendiceal, and Anal Carcinoma eighth edition (JCCAC).

Results

354 patients with 358 PSBC were enrolled. The average age of enrolled patients was 64.4 years, with 218 males (61.6%). The average tumor size was 49.9 mm, and the rate of PSBC’s site in the jejunum was 66.2%, while in the ileum was 30.4%. Of the 354 enrolled, 19 patients (5.4%) were diagnosed with Lynch syndrome, and 272 (76.8%) had symptoms at the initial diagnosis. Single-balloon endoscopy, double-balloon endoscopy and capsule endoscopy were used for diagnosis in 43 patients (12%), 166 (47%) and 43 (12%), respectively. Surgical resection was the most performed to the 291 patients (82.2%) for treatment and in those 115 patients (32.5%) underwent chemotherapy after surgical resection. In this study, the rate of each stage (0, I, II, III, IV) was 5.3%, 2.5%, 27.0%, 25.8% and 36.2%, respectively. The average follow-up period was 31.0 ± 30.8 months. Among the 217 patients with PSBC in stages 0 to III, there were 51 recurrences. The recurrence rate of each stage was stage 0: 5.3% (1/19), stage I: 11.1% (1/9), stage II: 18.6% (18/97) and stage III: 33.7% (31/92), respectively. The most common site of metastasis at first diagnosis (stage IV) was the peritoneum (55.8%). The 5-year overall survival rate in each stage was 92.3%, 60.0%, 75.9%, 61.4% and 25.5%, while the 5-year disease-specific survival (DSS) rate in each stage was 100%, 75.0%, 84.1%, 59.3% and 25.6%, respectively. The site of PSBC in the jejunum had a significantly lower 5-year DSS rate than that in the ileum (50.8% vs 66.7%, p=0.0418). The patients with symptoms at initial diagnosis had a significantly lower 5-year DSS rate than patients without symptoms (51.2% vs 70.5%, p=0.0416).

Conclusion

We have identified the characteristics and prognosis of PSBC in a large number of patients. 76.8% of patients with PSBC already had symptoms at the initial diagnosis and were often detected at the advanced stage. To improve the prognosis of PSBC, identifying with high-risk patients such as Lynch syndrome and screening should be examined, and the PSBC should be detected and treated in the early stages before symptoms appear.

Conference

UEG Week Copenhagen 2023

Topics

Small Intestine & Nutrition

Submission format

Abstract

Session

PP 03 Small intestinal (Posters)

Citation

United European Gastroenterology Journal 2023; 11 (Supplement 8)

Published

2023

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