Small bowel adenocarcinoma (SBA) is a rare tumour. Data are coming from register study or monocentric retrospective studies. The purpose of the NADEGE cohort is to describe characteristics and prognosis of SBA in unselected patients (pts) at a nationwide level.
All the pts with a SBA diagnosed from January 2009 to December 2012 were enrolled in the NADEGE cohort. The study involved 74 centres that enrolled 347 eligible pts.
Pts were predominantly male (59%), median age: 63 years [23-90]. Primary locations were duodenum (60.6%), jejunum (20.7%) and ileum (18.7%). The tumour was poorly differentiated (20.9%), moderately (38.6%), well differentiated (40.5%) and not determined (7.5%). A predisposing disease was reported in 68 (19.7%) cases: Crohn disease 30 (8.6%), Lynch syndrome 24 (6.9%), familial adenomatous polyposis (FAP) 6 (1.8%), celiac disease 6 (1.8%) and Peutz-Jeghers syndrome 2 (0.6%). The tumour was metastatic at diagnostic in 122 (35.2%) pts, localized and resected in 202 (58.2%) and locally advanced in 19 (5.5%). Crohn disease was significantly associated with younger age, poor differentiation and ileum primary and Lynch syndrome with younger age, poor differentiation, early stage and duodenal primary. Adjuvant chemotherapy was performed in 61.5% pts with locally resected tumour mainly with oxaliplatin based regimen (89.9%). Palliative chemotherapy was performed in 85.1% of pts with metastases mainly with oxaliplatin based regimen (69.8%). With a median follow-up of 54 months, the 5 years overall survival (OS) rate was 87%, 78% and 55% for stage I, II, III respectively and the median survival was 12.7 months for stage IV. In pts with resected tumour multivariate analysis revealed a higher risk of death associated to poor differentiation (HR = 1.85, 95%CI 1.01-3.39, p = 0.047) and T4 (HR = 2.51, 95%CI 1.45-4.36, p = 0.001). Stage IV pts treated by chemotherapy had a better survival than pts not treated (14.3 vs 2.2 months, p = 0.0002).
NADEGE cohort provide data on SBA treated in a recent period. Tumours characteristics differ according to predisposing disease. FOLFOX chemotherapy is the main regimen used in adjuvant and metastatic setting. Tumour grade and T stage are prognostic factors for OS in resected tumour.
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All authors have declared no conflicts of interest.