title: Duodenal adenocarcinoma: clinicopathologic analysis and implications for treatment.
abstract: BACKGROUND
  Duodenal adenocarcinoma is a rare cancer usually studied as a group with periampullary or small bowel adenocarcinoma; therefore, its natural history is poorly understood.
  
  
  METHODS
  Patients with duodenal adenocarcinoma were identified from a single-institution pancreaticoduodenectomy database. Patients with adenocarcinoma arising from the ampulla of Vater were excluded. Univariate and multivariate analyses were performed to identify clinicopathologic variables associated with survival and recurrence after resection.
  
  
  RESULTS
  From 1984 to 2006, a total of 122 patients with duodenal adenocarcinoma underwent pancreaticoduodenectomy. Overall survival after resection was 48% at 5 years and 41% at 10 years. Five-year survival decreased as the number of lymph nodes involved by metastasis increased from 0 to 1-3 to ≥ 4 (68%, 58%, 17%, respectively, P < 0.01) and as the lymph node ratio increased from 0 to >0-0.2 to >0.2-0.4 to >0.4 (68%, 57%, 14%, 14%, respectively, P < 0.01). Lymph node metastasis was the only independent predictor of decreased survival in multivariate analysis. Recurrence after resection was predominantly distant (81%). Adjuvant chemoradiation did not decrease local recurrence or prolong overall survival; however, patients who received chemoradiation more commonly had nodal metastasis (P = 0.03).
  
  
  CONCLUSIONS
  The prognostic significance of both the absolute number and ratio of involved lymph nodes emphasizes the need for adequate lymphadenectomy to accurately stage duodenal adenocarcinoma. The mostly distant pattern of recurrence underscores the need for the development of effective systemic therapies.
authors.affiliation: Department of Surgery, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
authors.forename: George A
authors.initials: GA
authors.lastname: Poultsides
authors.forename: Lyen C
authors.initials: LC
authors.lastname: Huang
authors.forename: John L
authors.initials: JL
authors.lastname: Cameron
authors.forename: Richard
authors.initials: R
authors.lastname: Tuli
authors.forename: Leslie
authors.initials: L
authors.lastname: Lan
authors.forename: Ralph H
authors.initials: RH
authors.lastname: Hruban
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Pawlik
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Herman
authors.forename: Barish H
authors.initials: BH
authors.lastname: Edil
authors.forename: Nita
authors.initials: N
authors.lastname: Ahuja
authors.forename: Michael A
authors.initials: MA
authors.lastname: Choti
authors.forename: Christopher L
authors.initials: CL
authors.lastname: Wolfgang
authors.forename: Richard D
authors.initials: RD
authors.lastname: Schulick
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality* / Q000473:pathology* / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004379:Duodenal Neoplasms / Q000401:mortality* / Q000473:pathology* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality* / Q000473:pathology* / Q000601:surgery; D009367:Neoplasm Staging; D016577:Pancreaticoduodenectomy / Q000401:mortality*; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate