Abstract
As primary duodenal adenocarcinoma is rare, the prognostic factors of this disease remain insufficiently explored, especially in China. We identified postoperative duodenal adenocarcinoma patients at a Chinese double-center (from 2006 to 2016) or who were registered with the Surveillance, Epidemiology, and End Results (SEER) database (from 2004 to 2014). Clinicopathological features and significant prognostic factors for cancer-specific survival (CSS) were reviewed and analyzed by using univariate and multivariate Cox proportional hazards regression. Then, a nomogram predicting CSS was constructed based on the SEER database and validated externally by using the separate Chinese cohort. Totally, 137 patients from the Chinese double-center and 698 patients from the SEER database were included for analysis. The multivariate analyses showed that age, tumor grade and TNM stage were independent prognostic factors. The nomogram constructed using these factors showed a clear prognostic superiority to the AJCC-TNM classification, 7th ed. (C-index: SEER cohort, 0.693 vs 0.625, P < 0.001; Chinese cohort, 0.677 vs 0.659, P < 0.001, respectively). In summary, the valuable prognostic factors in patients with duodenal adenocarcinoma were age, tumor grade and TNM stage. This study developed a nomogram that can precisely predict the CSS for postoperative duodenal adenocarcinoma patients.
Highlights
Primary duodenal adenocarcinoma is a rare but extremely aggressive tumor that account for less than 0.5% of gastrointestinal malignancy
The median follow-up for the survivors was 26 months in the Chinese cohort compared with 20.5 months in the SEER cohort
We evaluated the clinicopathological characteristics and independent prognostic factors in duodenal adenocarcinoma patients who underwent surgical excision from the Chinese double-center and the SEER database
Summary
Primary duodenal adenocarcinoma is a rare but extremely aggressive tumor that account for less than 0.5% of gastrointestinal malignancy. Diagnosis of duodenal adenocarcinoma is often delayed because the symptoms are nonspecific, with nearly half of patients presenting with abdominal pain. This situation resulted in negative influences on the survival outcome[3,4]. Most studies recognize regional lymph node metastasis as having a negative impact on survival[7,8,9]. Prognostic factors such as age, sex, tumor size, tumor grade and T stage are inconsistently associated with outcomes, and such discrepancies are likely due to small sample sizes[10]. We used the independent Chinese cohort for external validation
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