Non-ampullary duodenal adenocarcinoma: factors important for relapse and survival.

Overview

BACKGROUND: Duodenal adenocarcinoma (DA) is rare, but potentially curable. Prospective data on treatment outcomes is scarce and large retrospective studies show conflicting results on the impact of radical resection, node-status, and adjuvant therapy. METHODS: In the past 17 years, 30 patients presented with resectable DA. Data on the aforementioned variables were acquired then analyzed for impact on recurrence and survival. RESULTS: Overall-survival rates at 1, 2, and 3 years were 70.0%, 53.3%, and 33.3% respectively. Recurrence-free survival rates at 1, 2, and 3 years were 53.3%, 30.0%, and 26.7%. Overall-survival rates for patients with node-positive disease at 1, 2, and 3 years were 68.8%, 43.8%, 12.5%, and for node-negative 70%, 60%, 60%. Recurrence-free survival in node-positive disease at 1, 2, 3 years was 50%, 12.5%, 12.5%, and for node negative 50%, 50%, and 40%. Median survival from diagnosis was 27.5 months (0.5-226.7 months). Significant predictors of recurrence and survival were nodal-status and AJCC stage (P < 0.001). Adjuvant therapy, surgical-type, pathological tumor-stage, and surgical margins were not significant. CONCLUSION: Nodal-status and overall pathological-stage significantly affect the prognosis for patients with DA, while resection-status and adjuvant therapy may not. The role of adjuvant therapy requires prospective trials for elucidation.