原发性小肠恶性肿瘤55例临床分析

Clinical analysis of 55 cases of primary small bowel adenocarcinoma

目的:分析原发性小肠恶性肿瘤的发病特点、治疗、预后及其相关因素。方法:回顾性分析55例小肠恶性肿瘤患者的临床资料,对其中有完整随访资料的33例小肠腺癌患者进行分期和化疗与预后相关性的分析。结果:小肠恶性肿瘤多发于男性,平均发病年龄61岁;十二指肠为高发部位,占76.4%;病理类型以腺癌为主,占78.2%。在33例有完整随访资料的小肠腺癌患者中,Ⅰ和Ⅱ期患者(18例)的中位生存期为36个月,1、2和5年生存率分别为81.6%、68.0%和45.3%;Ⅲ和Ⅳ期患者(15例)的中位生存期为10个月,1和2年生存率分别为46.7%和20.0%;Ⅱ期和Ⅲ、Ⅳ期的生存率比较差异有统计学意义(P=0.010)。10例接受化疗患者(Ⅱ期3例、Ⅲ期4例、Ⅳ期3例)的中位生存期为20个月,1、2和5年生存率分别为70.0%,40.0%和26.7%;23例未化疗者的中位生存期为24个月,1、2和5年生存率分别为68.7%,46.5%和34.9%;化疗者和未化疗者生存率比较,差异无统计学意义(P=0.773)。结论:原发性小肠恶性肿瘤好发于十二指肠,晚期患者预后较差,化疗效果不理想。对于进展期小肠腺癌患者给予适当的化疗,可能有所获益。

Objective：To investigate the clinical and pathologic features, treatment, prognosis, and related factors of primary small bowel adenocarcinoma. Methods： Retrospective analysis was performed on the clinical data from the 55 cases of primary small bowel adenocarcinoma. This study analyzed the correlation of clinical staging and chemotherapy with prognosis based on 33 patients who had complete follow-up data. Results：Intestinal malignant tumor occurred most in male patients. There were 36 men and 19 women with a median age of 61 years. Most tumors were originated in the duodenum （76.4%）. Adenocarcinoma （78.2%） was the main pathologi- cal classification. The median survival period was 36 months for the 18 patients in stage Ⅰand stage Ⅱ. The 1-, 2-, and 5-years survival rates were 81.6%, 68.0%, and 45.3%, respectively. The median survival period was 10 months for patients in stage Ⅲ and IV. The 1 - and 2-year survival rates were 46.7% and 20.0% , respectively. The difference was significant between patients in different groups metioned above （P =0. 010）. The median survival time was 20 months for the patients who received chemotherapy （3 at stage Ⅱ , 4 at stage In, 3 at stage Ⅳ）. The 1-, 2- and 5-year survival rates were 70.0% , 40.0% , and 26.7% , respectively. The median survival time was 24 months for the patients who did not receive chemotherapy. The 1-, 2- and 5- year survival rates were 68.7%, 46.5% , and 34.9% , respectively. The difference was significant between the patients who received chemotherapy and those who did not receive chemotherapy （ P = 0. 773 ）. Conclusion ： Primary small bowel adenocareinoma occurred frequently in the duodenum. The patients with advanced primary small bowel adenocarcinoma had poor prognosis and low efficacy of chemotherapy. It will be beneficial to give proper chemotherapy to the patients with advanced primary small bowel adenocarcinoma.