Retrospective Cohort Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Feb 27, 2025; 17(2): 101365
Published online Feb 27, 2025. doi: 10.4240/wjgs.v17.i2.101365
Long-term survival outcomes of duodenal adenocarcinoma: A cohort study with 15-year single-center experience
Qing-Feng Xie, Lian-Sheng Long, Yang-Yang Luo, Meng-Ting Lu, Wai-Kit Ming, Li-Ying Zhao, Hao Liu
Qing-Feng Xie, Lian-Sheng Long, Yang-Yang Luo, Meng-Ting Lu, Li-Ying Zhao, Hao Liu, Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong Province, China
Lian-Sheng Long, Department of General Surgery, General Hospital of Southern Theater Command, Guangzhou 510515, Guangdong Province, China
Wai-Kit Ming, Department of Infectious Diseases and Public Health, Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, Hong Kong 999077, China
Co-first authors: Qing-Feng Xie and Lian-Sheng Long.
Co-corresponding authors: Wai-Kit Ming and Hao Liu.
Author contributions: Xie QF and Long LS contribute equally to this study as co-first authors; Ming WK and Liu H contribute equally to this study as co-corresponding authors; all authors were involved in concept and design; Xie QF, Chen T, Luo YY were involved in data acquisition, analysis or interpretation; Xie QF, Chen T, Luo YY, Lu MT were involved in drafting of the manuscript; Liu H, Zhao LY, Ming WK were involved in modification of important knowledge content of manuscript; Xie QF and Liu H were involved in statistical analysis; Ming WK was involved in administrative, technical or material support.
Supported by Natural Science Foundation of Guangdong Province of China, No. 2023A1515010785; Key Clinical Technique of Guangzhou, No. 2023P-ZD01; and Clinical Research Program of Nanfang Hospital, Southern Medical University, No. 2021CR003.
Institutional review board statement: The study was conducted in accordance with the Declaration of Helsinki and was approved by the ethical committee of the related institution (NFEC-2024-171).
Informed consent statement: We have obtained informed consent from patients for this clinical study.
Conflict-of-interest statement: All the authors declare no conflicts of interest, financial or otherwise.
Data sharing statement: Data were obtained from duodenal cancer database of Nanfang Hospital, Guangzhou, China, so data sharing does not apply to this article.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hao Liu, MD, PhD, Associate Professor, Department of General Surgery, Nanfang Hospital, Southern Medical University, North No. 1838 Guangzhou Ave., Guangzhou 510515, Guangdong Province, China. liuhaofbi@163.com
Received: September 12, 2024
Revised: October 25, 2024
Accepted: November 25, 2024
Published online: February 27, 2025
Processing time: 132 Days and 5.6 Hours
Abstract
BACKGROUND

Duodenal adenocarcinoma (DA), a rare gastrointestinal malignancy, lacks clear natural history and management strategies. This study aimed to investigate the long-term outcomes of patients with DA, focusing on long-term survival and the impact of tumor characteristics, surgery, and adjuvant therapy.

AIM

To bridge this knowledge gap, we conducted a hospital-based cohort study in our 15-year experience with DA aimed at investigating the long-term outcomes of the patients with DA, along with analyzing the impact of the tumor characteristics, operations and adjuvant therapy on survival outcomes.

METHODS

A retrospective analysis of 208 patients diagnosed with non-ampullary DA at a single institution between 2009 and 2023 was performed. This study used SPSS 26.0 software to make a comprehensive statistical analysis of demographic characteristics, clinical presentation, treatment modalities, and survival outcomes. The effectiveness of surgical resection and adjuvant therapy in 5-year oval survival (OS) and disease-free survival was evaluated using Kaplan-Meier survival curves, the Cox proportional hazards model, and statistical comparisons of survival distributions.

RESULTS

The median OS time for the cohort was 39 months, with 3- and 5-year OS rates of 51.2% and 43.6%, respectively. Radical resection was performed in 82.6% of cases, and was significantly associated with an improved 5-year OS, with a rate of 57.8%. Adjuvant therapy showed a survival benefit in the specific patient subsets, particularly in tumor stage II or III tumors, with an improved OS. Adjuvant therapy (hazard ratio= 2.71, 95% confidence interval: 1.30-5.62, P = 0.008), pancreatic invasion and advanced tumor stage were identified as significant predictors of OS in multivariate analyses.

CONCLUSION

Radical operation for DA is associated with a remarkable improvement in the 5-year OS. Importantly, postoperative adjuvant therapy can significantly prolong the OS time in patients with radical operation, especially in patients with stage III. It highlights the necessity for early diagnosis, tailored surgical approaches, and a nuanced understanding of the role of adjuvant therapy.

Keywords: Duodenal adenocarcinoma; Overall survival time; Disease-free survival time; Pancreaticoduodenectomy; Adjuvant therapy

Core Tip: Numerous meta-analyses and systematic reviews have delved into the treatment of duodenal adenocarcinoma (DA), yet the majority of the studies retrospective, single-center, and small sample size series, particularly in China. To bridge this knowledge gap, we conducted a hospital-based cohort study in our 15-year experience with DA aimed at investigating the long-term outcomes of the patients with DA, along with analyzing the impact of the tumor characteristics, operations and adjuvant therapy on survival outcomes.