title: Prognostic factors and treatment outcomes in patients with Small Bowel Adenocarcinoma (SBA): the Royal Marsden Hospital (RMH) experience.
abstract: BACKGROUND
  SBA is a rare tumour which carries a poor prognosis. Very few data on prognostic factors and treatment outcomes are available. We conducted a retrospective analysis of patients treated for SBA at our institution.
  
  
  METHODS
  Clinico-pathological characteristics, treatments and outcomes of all the SBA patients treated consecutively from 1996 to 2011 were retrospectively collected. The prognostic value of baseline factors was assessed using the Cox regression model. The Kaplan-Meier method was used to estimate the survival outcomes.
  
  
  RESULTS
  Eighty-four patients with SBA were treated during the study period. Of these, 48 presented with early stage SBA, while 36 had unresectable disease. All early stage SBA patients (58.3% males; median age, 59 years) underwent resection (R0 in 44/48) and 27 (56%) received adjuvant chemotherapy. Median relapse-free survival and overall survival (OS) were 31.1 months (95% CI: 8.0-54.3) and 42.9 (95% CI: 0-94.9), respectively. In univariate analyses, poor histological differentiation (p = 0.025) and lymphovascular invasion (p = 0.003) were prognostic for OS. In the group of patients with relapsed, unresectable or metastatic disease (n = 59), systemic chemotherapy was administered in 46 cases (78%). The response rate to first line chemotherapy was 50%. Median progression-free survival and OS were 8.8 (95% CI: 5.5-12.3) and 12.8 months (95% CI: 8.4-17.2), respectively. In univariate analyses, low albumin (p = 0.041) and high platelet count (p = 0.007) were prognostic for OS.
  
  
  CONCLUSIONS
  Prospective clinical trials are needed to inform the management of SBA patients. Prognostic factors evaluated in our series may be useful for patient stratification and treatment selection in future studies.
authors.affiliation: Department of Medicine, GI and Lymphoma Unit, The Royal Marsden NHS Foundation Trust, London and Surrey, UK. khurum.khan@icr.ac.uk.
authors.forename: Khurum
authors.initials: K
authors.lastname: Khan
authors.affiliation: Department of Medicine, GI and Lymphoma Unit, The Royal Marsden NHS Foundation Trust, London and Surrey, UK. clare.peckitt@rmh.nhs.uk.
authors.forename: Clare
authors.initials: C
authors.lastname: Peckitt
authors.affiliation: Department of Medicine, GI and Lymphoma Unit, The Royal Marsden NHS Foundation Trust, London and Surrey, UK. francesco.sclafani@rmh.nhs.uk.
authors.forename: Francesco
authors.initials: F
authors.lastname: Sclafani
authors.affiliation: Department of Medicine, GI and Lymphoma Unit, The Royal Marsden NHS Foundation Trust, London and Surrey, UK. david.watkins@rmh.nhs.uk.
authors.forename: David
authors.initials: D
authors.lastname: Watkins
authors.affiliation: Department of Medicine, GI and Lymphoma Unit, The Royal Marsden NHS Foundation Trust, London and Surrey, UK. sheela.rao@rmh.nhs.uk.
authors.forename: Sheela
authors.initials: S
authors.lastname: Rao
authors.affiliation: Department of Medicine, GI and Lymphoma Unit, The Royal Marsden NHS Foundation Trust, London and Surrey, UK. naureen.starling@rmh.nhs.uk.
authors.forename: Naureen
authors.initials: N
authors.lastname: Starling
authors.affiliation: Department of Medicine, GI and Lymphoma Unit, The Royal Marsden NHS Foundation Trust, London and Surrey, UK. vikramjain02@gmail.com.
authors.forename: Vikram
authors.initials: V
authors.lastname: Jain
authors.affiliation: Department of Medicine, GI and Lymphoma Unit, The Royal Marsden NHS Foundation Trust, London and Surrey, UK. sachin.trivedi@rmh.nhs.uk.
authors.forename: Sachin
authors.initials: S
authors.lastname: Trivedi
authors.affiliation: Department of Medicine, GI and Lymphoma Unit, The Royal Marsden NHS Foundation Trust, London and Surrey, UK. susannah.stanway@rmh.nhs.uk.
authors.forename: Susannah
authors.initials: S
authors.lastname: Stanway
authors.affiliation: Department of Medicine, GI and Lymphoma Unit, The Royal Marsden NHS Foundation Trust, London and Surrey, UK. david.cunningham@rmh.nhs.uk.
authors.forename: David
authors.initials: D
authors.lastname: Cunningham
authors.affiliation: Department of Medicine, GI and Lymphoma Unit, The Royal Marsden NHS Foundation Trust, London and Surrey, UK. ian.chau@rmh.nhs.uk.
authors.forename: Ian
authors.initials: I
authors.lastname: Chau
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy / Q000473:pathology*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007421:Intestine, Small / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy / Q000473:pathology*; D011379:Prognosis; D016896:Treatment Outcome