Is there a role for adjuvant therapy in resected adenocarcinoma of the small intestine

Figures & data

Table I. Patient and treatment characteristics by treatment group.

Characteristic	No adjuvant (N = 24)	Adjuvant (N=30)	P-value
Age, years			0.025
Median	61	52
Range	34–79	31–78
Sex			0.57
Female	9 (38%)	8 (27%)
Male	15 (62%)	22 (73%)
Small bowel site			0.16
Duodenum	19 (79%)	17 (57%)
Jejunum	4 (17%)	7 (23%)
Ileum	1 (4%)	6 (20%)
Differentiation			0.39
Well/moderate	16 (67%)	18 (60%)
Poorly	7 (29%)	12 (40%)
Not specified	1 (4%)	0
Mucinous histology
Yes	4 (17%)	7 (23%)	0.74
No	20 (83%)	23 (77%)
TNM stage			0.001
I	8 (33%)	0
II	9 (38%)	11 (37%)
III	7 (29%)	19 (63%)
T stage			0.008
1	1 (4%)	0
2	8 (33%)	1 (3%)
3	11 (46%)	18 (60%)
4	4 (17%)	11 (37%)
Nodal involvement	7 (29%)	19 (63%)	0.013
Lymph node ratio			0.032
Median	0%	12%
Range	0–58%	0–100%
Lymph node ratio ≥ 10%	5 (21%)	15 (50%)	0.027
LVSI (stages I and II only)	6 (35%)	3 (27%)	1

LVSI, lymphovascular space invasion.

Table II. Adjuvant treatment.

Treatment	No. of patients (%)
Chemotherapy	18 (60)
5-FU	10
5-FU/platinum ^a
Capecitabine	2
CAPOX	1
5-FU/irinotecan	1
Chemotherapy and Radiation	7 (23)
CAPOX + Capecitabine/Xrt	5
5-FU/cisplatin + 5-FU/Xrt	1
5-FU/cisplatin + Capecitabine/Xrt	1
Chemoradiation	3 (10)
Capecitabine/Xrt	2
5-FU/Xrt	1
Radiation therapy	2 (7)

5-FU: 5-flurouracil; CAPOX: capecitabine/oxaliplatin; Xrt: radiation therapy; ^acisplatin (1 patient), cisplatin and etoposide (1 patient), carboplatin (1 patient), oxaliplatin (1 patient).

Table III. Univariate Cox proportional hazards model in estimating the association between patient characteristics and survival.

	Disease-free survival			Overall survival
Characteristic	HR	95% CI	P	HR	95% CI	P
Age (1 year increase)	1.012	0.97–1.05	0.545	0.995	0.96–1.04	0.805
Poorly differentiated	3.394	1.11–10.4	0.032	8.997	1.94–41.67	0.005
Lymph node ratio ≥ 10%	4.293	1.43–12.89	0.009	4.268	1.27–14.29	0.019
Nodal involvement	3.221	1.01–10.31	0.049	3.681	0.99–13.67	0.052
Tumor stage
T3 vs. T2	0.706	0.182–2.741	0.615	2.036	0.25–16.29	0.511
T4 vs. T2	1.097	0.25–4.91	0.904	5.103	0.59^14.11	0.139
LVSI (stages I and II only)	3.677	0.48–28.02	0.209	1.632	0.15–18.39	0.692
Adjuvant treatment	0.81	0.28–2.32	0.695	0.891	0.29–2.77	0.842
Duodenal primary	0.589	0.20–1.78	0.347	0.463	0.15–1.47	0.19

CI, confidence interval; HR, hazard ratio; LVSI, lymphovascular space invasion.

Figure 1. Kaplan-Meier plots stratified by use of adjuvant chemotherapy for disease-free survival (A) and overall survival (B).

Table IV. Multivariate Cox proportional hazard ratios for DFS/OS.

Outcome/predictor	HR	95% CI	P
Disease-free survival
Lymph node ratio ≥10%	8.543	2.20–33.16	<0.01
Poor differentiation	4.127	1.28–13.36	0.02
Adjuvant treatment	0.270	0.07–0.98	0.05
Overall survival
Lymph node ratio ≥10%	5.730	1.38–22.75	0.02
Poor differentiation	8.406	1.79–39.54	0.01
Adjuvant treatment	0.466	0.13–1.62	0.23

CI, confidence interval; HR, hazard ratio.

Figure 2. Kaplan-Meier plots stratified by lymph node involvement (LNI) and use of adjuvant chemotherapy. Disease-free survival (A) and overall survival (B) in patients with lymph node involvement of ≥10%.