Trends in incidence, treatment and survival of small bowel adenocarcinomas between 1999 and 2013: a population-based study in The Netherlands

Figures & data

Table 1. Characteristics of patients diagnosed with a small bowel adenocarcinoma, by primary tumor localization (n = 1775).

	Total N (%)	Duodenum N (%)	Non-Duodenum N (%)	p-value
Sex
Male	909 (51.2)	541 (52.7)	368 (49.1)	0.1343
Female	866 (48.8)	485 (47.3)	381 (50.9)
Age (years)
<50	178 (10.0)	84 (8.2)	94 (12.6)	0.0028
50-59	281 (15.8)	155 (15.1)	126 (16.8)
60-69	458 (25.8)	257 (25.1)	201 (26.8)
70-79	509 (28.7)	307 (29.9)	202 (27.0)
≥80	349 (19.7)	223 (21.7)	126 (16.8)
Location primary tumor
Duodenum	1026 (57.8)	1026 (100.0)	Not applicable	n.a.
Jejunum	336 (18.9)	Not applicable	336 (44.9)
Ileum	257 (14.5)	Not applicable	257 (34.3)
Overlapping	42 (2.4)	Not applicable	42 (5.6)
Unknown/NOS	114 (6.4)	Not applicable	114 (15.2)
TNM stage group
I	115 (6.5)	66 (6.4)	49 (6.5)	<0.0001
II	501 (28.2)	219 (21.4)	282 (37.7)
III	419 (23.6)	257 (25.1)	162 (21.6)
IV	581 (32.7)	352 (34.3)	229 (30.6)
X	159 (9.0)	132 (12.9)	27 (3.6)
Number of metastatic sites
1	447 (76.9)	286 (81.3)	161 (70.3)	0.0092
2	97 (16.7)	48 (13.6)	49 (21.4)
≥3	37 (6.4)	18 (5.1)	19 (8.3)
Period of diagnosis
1999-2003	436 (24.6)	233 (22.7)	203 (27.1)	0.0207
2004-2008	559 (31.5)	315 (30.7)	244 (32.6)
2009-2013	780 (43.9)	478 (46.6)	302 (40.3)
Surgery
Yes	1045 (58.9)	418 (40.7)	627 (83.7)	<0.0001
No	730 (41.1)	608 (59.3)	122 (16.3)
Chemotherapy
Yes	321 (18.1)	165 (16.1)	156 (20.8)	0.0103
No	1454 (81.9)	861 (83.9)	593 (79.2)
Total	1775	1026	749

NOS: not otherwise specified.

Figure 1. Primary tumor location within the small bowel for patients diagnosed with a small bowel adenocarcinoma between 1999 and 2013 in the Netherlands according to period of diagnosis (n = 1775).

Table 2. Crude percentages and adjusted odds for receiving chemotherapy among patients diagnosed with small bowel adenocarcinomas between 1999–2013 in the Netherlands, by extent of disease (n = 1775).

	Locoregional disease (n = 1194)		Metastatic disease (n = 581)
	Crude percentage (%)	Odds ratios (95% CI)	Crude percentage (%)	Odds ratios (95% CI)
Sex
Male	12.1	1.00 (reference)	31.0	1.00 (reference)
Female	9.9	0.85 (0.57–1.27)	34.0	1.18 (0.80–1.73)
Age (years)
<50	25.9	2.16 (1.22–3.81)	56.5	1.99 (1.08–3.67)
50–59	18.9	1.54 (0.92–2.59)	51.1	1.63 (0.95–2.78)
60–69	16.0	1.00 (reference)	39.4	1.00 (reference)
70–79	5.6	0.34 (0.19–0.61)	23.7	0.48 (0.29–0.78)
≥80	0.0	Not applicable	3.2	0.05 (0.02–0.16)
Location primary tumor
Duodenum	9.5	1.00 (reference)	28.7	1.00 (reference)
Jejunum	13.0	1.61 (0.97–2.68)	43.3	1.49 (0.90–2.48)
Ileum	15.1	2.00 (1.16–3.47)	34.7	1.16 (0.64–2.12)
Overlapping	8.3	1.03 (0.21–5.02)	38.9	1.11 (0.40–3.06)
Unknown/NOS	9.7	1.28 (0.52–3.16)	33.3	1.33 (0.61–2.86)
TNM stage group
I	0.0	Not applicable	Not included in the analysis
II	7.6	1.00 (reference)
III	20.8	3.45 (2.22–5.35)
X	4.4	1.89 (0.77–4.66)
Period of diagnosis
1999–2003	6.6	1.00 (reference)	18.6	1.00 (reference)
2004–2008	9.8	1.74 (0.96–3.16)	34.7	2.31 (1.27–4.19)
2009–2013	15.0	3.10 (1.79–5.38)	36.9	3.00 (1.72–5.26)

NOS: not otherwise specified.

Table 3. Crude median overall survival, crude 1-year survival, crude 5-year survival, adjusted hazard ratios with and without adjustment for treatment for patients diagnosed with locoregional small bowel adenocarcinoma between 1999 and 2013 in the Netherlands (n = 1194).

	Crude median overall survival (months)	Crude 1-year survival (%)	Crude 5-year survival (%)	Multivariate HR (95% CI)^a	Multivariate HR (95% CI) adjusted for treatment^a
Sex
Male	26.1	65.8	35.6	1.00 (reference)	1.00 (reference)
Female	24.5	64.7	35.5	0.87 (0.75–1.00)	0.82 (0.71–0.95)
Age (years)
<50	73.0	84.9	52.3	0.61 (0.44–0.83)	0.66 (0.48–0.91)
50–59	66.4	79.8	53.6	0.66 (0.51–0.86)	0.68 (0.53–0.89)
60–69	32.4	72.1	40.0	1.00 (reference)	1.00 (reference)
70–79	21.9	62.8	32.1	1.34 (1.09–1.64)	1.21 (0.98–1.48)
≥80	7.9	40.9	13.7	2.18 (1.76–2.71)	1.52 (1.21–1.90)
Location primary tumor
Duodenum	16.3	57.8	28.1	1.00 (reference)	1.00 (reference)
Jejunum	62.6	81.9	50.9	0.62 (0.51–0.77)	0.93 (0.74–1.16)
Ileum	40.2	73.3	42.8	0.79 (0.63–0.98)	1.22 (0.97–1.54)
Overlapping	41.3	79.1	33.4	0.76 (0.45–1.29)	0.97 (0.58–1.65)
Unknown/NOS	22.6	55.5	37.1	0.75 (0.55–1.02)	1.12 (0.82–1.54)
TNM stage group
I	77.2	84.8	60.3	0.39 (0.29–0.53)	0.42 (0.31–0.56)
II	42.7	73.4	44.7	0.65 (0.55–0.77)	0.63 (0.53–0.75)
III	20.5	65.0	29.3	1.00 (reference)	1.00 (reference)
X	4.7	26.4	5.7	1.73 (1.39–2.17)	0.85 (0.67–1.07)
Period of diagnosis
1999–2003	18.5	61.3	27.7	1.00 (reference)	1.00 (reference)
2004–2008	23.1	63.7	37.3	0.87 (0.73–1.03)	0.84 (0.70–0.99)
2009–2013	34.1	69.4	40.8	0.68 (0.56–0.81)	0.74 (0.61–0.89)
Surgery
Yes	50.3	79.8	47.9	Not included in the analysis	0.23 (0.18–0.28)
No	5.6	73.6	3.2		1.00 (reference)
Chemotherapy
Yes	35.5	84.3	41.1	Not included in the analysis	0.55 (0.41–0.73)
No	23.5	63.0	34.9		1.00 (reference)

NOS: not otherwise specified.

^aadjusted for all variables listed.

Table 4. Crude median overall survival, crude 1-year survival, crude 5-year survival, adjusted hazard ratios with and without adjustment for treatment for patients diagnosed with metastatic small bowel adenocarcinoma between 1999 and 2013 in the Netherlands (n = 581).

	Crude median overall survival (months)	Crude 1-year survival (%)	Crude 5-year survival (%)	Multivariate HR (95% CI)^a	Multivariate HR (95% CI) adjusted for treatment^a
Sex
Male	4.5	21.2	1.4	1.00 (reference)	1.00 (reference)
Female	5.1	30.5	3.9	0.89 (0.75–1.06)	0.90 (0.75–1.07)
Age (years)
<50	8.3	38.7	12.8	0.69 (0.50–0.95)	0.79 (0.57–1.08)
50–59	5.7	31.0	1.5	0.97 (0.73–1.27)	1.00 (0.76–1.32)
60–69	5.2	28.9	1.9	1.00 (reference)	1.00 (reference)
70–79	4.7	23.1	1.0	1.16 (0.93–1.46)	1.02 (0.81–1.29)
≥80	2.4	12.2	1.9	1.64 (1.26–2.15)	1.21 (0.91–1.60)
Location primary tumor
Duodenum	4.0	19.2	1.2	1.00 (reference)	1.00 (reference)
Jejunum	9.7	40.5	7.2	0.54 (0.42–0.70)	0.90 (0.68–1.18)
Ileum	5.0	29.9	7.5	0.74 (0.56–0.97)	1.57 (1.13–2.17)
Overlapping	4.9	29.6	0.0	0.83 (0.51–1.36)	1.19 (0.72–1.97)
Unknown/NOS	5.7	39.1	0.0	0.79 (0.56–1.12)	1.48 (1.03–2.15)
Period of diagnosis
1999–2003	4.5	27.1	3.8	1.00 (reference)	1.00 (reference)
2004–2008	4.8	27.7	2.9	0.92 (0.72–1.17)	1.10 (0.86–1.41)
2009–2013	5.2	23.9	1.7	0.95 (0.76–1.20)	1.12 (0.89–1.42)
Surgery
Yes	10.6	47.2	8.0	Not included in the analysis	0.38 (0.30–0.50)
No	3.9	16.6	0.4		1.00 (reference)
Chemotherapy
Yes	10.5	43.4	4.5	Not included in the analysis	0.50 (0.40–0.61)
No	3.2	17.5	1.9		1.00 (reference)

NOS: not otherwise specified.

^aadjusted for all variables listed.