title: Adenocarcinoma of the small bowel at a single Korean institute: management and prognosticators.
abstract: OBJECTIVE
  Small bowel adenocarcinoma (SBA) is a rare malignancy with a poor outcome. We evaluated the natural history of SBA at a single Korean institute.
  
  
  METHODS
  Medical records of 100 patients with SBA were reviewed for clinical characteristics, treatment patterns, outcomes, and prognostic factors.
  
  
  RESULTS
  The most common primary tumor site was the duodenum (82%). Seventy-four patients were diagnosed with stage III/IV disease (28/46 patients, respectively). Sixty-six patients had surgery (R0/R1/R2 in 32/2/32) without operation-related mortality. Of 34 R0/R1-resected patients, 16 received adjuvant chemotherapy. The dominant pattern of recurrence following R0/R1 resection was distant metastasis (29%; 10 of 34 patients). Thirty-four patients with advanced SBA received palliative chemotherapy, showing a response rate of 27.6% and a median progression-free survival of 3.8 months. The median overall survival for all patients and R0/R1-resected patients was 10.5 and 42.1 months, respectively. In multivariate analysis, lower stage, nonduodenal location, and R0/R1 resection were good independent prognostic factors.
  
  
  CONCLUSIONS
  Early diagnosis is crucial to improve outcomes of SBA with respect to increasing resectability. Distant metastasis as a dominant pattern of recurrence suggests a potential role for adjuvant chemotherapy. Newer antitumor agents in advanced SBA should be evaluated considering the poor efficacy of current palliative chemotherapy.
authors.affiliation: Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, 250 Seongsanno, Seodaemun-gu, Seoul, 120-752, Korea.
authors.forename: Yong Wha
authors.initials: YW
authors.lastname: Moon
authors.forename: Sun Young
authors.initials: SY
authors.lastname: Rha
authors.forename: Sang Joon
authors.initials: SJ
authors.lastname: Shin
authors.forename: Hyun
authors.initials: H
authors.lastname: Chang
authors.forename: Hyo Sup
authors.initials: HS
authors.lastname: Shim
authors.forename: Jae Kyung
authors.initials: JK
authors.lastname: Roh
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis* / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D017024:Chemotherapy, Adjuvant / Q000379:methods / Q000706:statistics & numerical data; D013505:Digestive System Surgical Procedures / Q000379:methods; D005260:Female; D006801:Humans; D007414:Intestinal Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D007421:Intestine, Small / Q000473:pathology; D007723:Korea; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012008:Recurrence; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult