Rak jelita cienkiego – Rokowania, prognozy i postęp choroby

Rak jelita cienkiego
Rokowania, prognozy i postęp choroby

Rokowanie w raku jelita cienkiego jest wieloczynnikowe i zależy przede wszystkim od stadium zaawansowania nowotworu, typu histologicznego, lokalizacji guza, możliwości całkowitego usunięcia chirurgicznego oraz obecności przerzutów, zwłaszcza do wątroby. 5-letnia przeżywalność netto wynosi około 54% (dane kanadyjskie) i 53% (dane angielskie), przy czym wczesne stadia (I-III) cechują się przeżywalnością odpowiednio 79%, 58% i 38%. Typy histologiczne różnią się rokowaniem: guzy neuroendokrynne (NETs) mają najlepsze prognozy (5-letnie przeżycie do 95% w stadium wczesnym), a gruczolakoraki najgorsze (5-letnie przeżycie spada do 4% w zaawansowanych stadiach). Usunięcie ≥8 węzłów chłonnych podczas resekcji wiąże się z lepszym rokowaniem, natomiast obecność przerzutów do wątroby znacząco pogarsza przeżycie. Czynniki molekularne, takie jak wysoki tumor mutational burden (TMB ≥10 mutacji/Mb) korelują z lepszym przeżyciem, natomiast mutacje SMAD4 i sprawna naprawa niesparowanych zasad (pMMR) są związane z gorszym rokowaniem i wyższym ryzykiem nawrotów.

Rokowanie w raku jelita cienkiego (Small bowel cancer Prognosis)

Ogólne wskaźniki przeżywalności
Czynniki wpływające na rokowanie
Czynniki genetyczne i molekularne
Wzorce nawrotów
Różnice demograficzne w rokowaniu
Niezależne czynniki prognostyczne
Znaczenie wczesnej diagnozy
Indywidualne podejście do rokowania
Przyszłość prognozowania raka jelita cienkiego
Kolejne rozdziały

Rokowanie w raku jelita cienkiego (Small bowel cancer Prognosis)

Rokowanie w raku jelita cienkiego jest złożonym zagadnieniem zależnym od wielu czynników. Prognoza i przeżywalność opierają się na analizie danych populacyjnych i statystykach, które mogą dostarczyć ogólnych informacji na temat odsetka pacjentów żyjących przez określony czas (zazwyczaj 5 lat) po diagnozie. Należy jednak podkreślić, że statystyki te nie mogą być wykorzystywane do przewidywania indywidualnych szans na przeżycie konkretnego pacjenta.¹²³

Ogólne wskaźniki przeżywalności

Według danych kanadyjskich, 5-letnia przeżywalność netto dla raka jelita cienkiego wynosi około 54%. Oznacza to, że około 54% osób z diagnozą raka jelita cienkiego przeżyje co najmniej 5 lat.¹ Dane z Anglii wskazują na podobny wskaźnik przeżywalności 5-letniej na poziomie 53%.² Należy jednak zaznaczyć, że osoby z tym typem nowotworu mogą żyć znacznie dłużej niż 5 lat.³

Przeżywalność różni się w zależności od stadium i typu raka jelita cienkiego, a także od tego, czy guz można całkowicie usunąć chirurgicznie (czy jest resekcyjny).⁴ Pacjenci obecnie diagnozowani z rakiem jelita cienkiego mogą mieć lepsze rokowanie niż wskazują na to obecne statystyki, ze względu na postęp w metodach diagnostycznych i leczniczych.⁵

Czynniki wpływające na rokowanie

Rokowanie w raku jelita cienkiego zależy od wielu czynników. Najważniejszymi z nich są:¹²

Stadium zaawansowania nowotworu w momencie rozpoznania – niższe stadium oznacza lepsze rokowanie
Typ histologiczny guza
Lokalizacja guza w jelicie cienkim
Możliwość całkowitego chirurgicznego usunięcia guza
Liczba usuniętych węzłów chłonnych podczas zabiegu
Obecność przerzutów, szczególnie do wątroby
Czynniki molekularne i genetyczne

¹²³

Stadium zaawansowania

Stadium zaawansowania jest najważniejszym czynnikiem prognostycznym w raku jelita cienkiego. Guzy ograniczone tylko do jelita cienkiego mają korzystniejsze rokowanie niż te, które przeniknęły przez ścianę jelita, rozprzestrzeniły się do węzłów chłonnych lub dały przerzuty odległe (przerzuty odległe).¹

5-letnie przeżycie dla pacjentów z rakiem jelita cienkiego w stadium patologicznym I, II i III wynosi odpowiednio 79%, 58% i 38%.² W przypadku gruczolakoraków wczesnego stadium, 65% pacjentów żyje 5 lat po diagnozie, podczas gdy w późniejszych stadiach wskaźnik ten spada do zaledwie 4%.³

Typ histologiczny

Rokowanie różni się znacząco w zależności od typu histologicznego raka jelita cienkiego. Ogólnie rzecz biorąc, typy raka jelita cienkiego od najbardziej do najmniej korzystnego rokowania to:¹

Guzy neuroendokrynne (NETs) – mają najlepsze rokowanie; wczesne guzy karcinoidalne mają 5-letni wskaźnik przeżycia 95%, podczas gdy w późniejszych stadiach wskaźnik ten wynosi 42%
Chłoniaki (chłoniak grudkowy ma najlepsze rokowanie ze wszystkich chłoniaków jelita cienkiego)
Nowotwory podścieliskowe przewodu pokarmowego (GISTs)
Mięsaki tkanek miękkich
Gruczolakoraki – mają najgorsze rokowanie spośród wszystkich typów

²³

Czynniki chirurgiczne

Guzy, które można całkowicie usunąć chirurgicznie, mają lepsze rokowanie niż te, których nie można całkowicie usunąć.¹ Dodatkowo, jeśli podczas zabiegu usunięto 8 lub więcej węzłów chłonnych, ryzyko nawrotu nowotworu jest mniejsze niż w przypadku usunięcia 7 lub mniej węzłów chłonnych. Dlatego pacjenci, u których usunięto 8 lub więcej węzłów chłonnych, mają lepsze rokowanie.²

Przerzuty do wątroby

Obecność przerzutów do wątroby jest istotnym czynnikiem prognostycznym wskazującym na gorsze rokowanie w raku jelita cienkiego. Pacjenci z przerzutami do wątroby mają znacząco gorsze przeżycie w porównaniu z tymi bez przerzutów do wątroby.¹²

Badania wykazały, że guzy pierwotne zlokalizowane w dolnej części jelita cienkiego, o niskim stopniu zróżnicowania, większych rozmiarach, w wyższym stadium N oraz z obecnością większej liczby miejsc przerzutów pozawątrobowych zwiększają skłonność do rozwoju przerzutów do wątroby.³

Czynniki genetyczne i molekularne

Postępy w badaniach genomicznych umożliwiły identyfikację markerów molekularnych, które mogą mieć znaczenie prognostyczne w raku jelita cienkiego.¹

Obciążenie mutacyjne guza (TMB)

Obciążenie mutacyjne guza (Tumor Mutational Burden, TMB) jest silnie związane z rokowaniem u pacjentów z rakiem jelita cienkiego. TMB jest miarą mutacji somatycznych na Mb DNA w komórkach nowotworowych. Pacjenci z TMB ≥10 mutacji/Mb wykazują znacząco lepsze przeżycie całkowite i przeżycie swoiste dla choroby w porównaniu z pacjentami z TMB <10 mutacji/Mb.¹²

Mutacje genu SMAD4

Mutacje genu SMAD4 są związane z gorszym przeżyciem wolnym od nawrotu (RFS) u pacjentów z rakiem jelita cienkiego. Pacjenci z mutacją SMAD4 mają znacząco gorsze RFS niż pacjenci z genem SMAD4 typu dzikiego.¹²

Status naprawy niesparowanych zasad (MMR)

W analizie jednoczynnikowej, sprawna naprawa niesparowanych zasad (pMMR) była związana ze zmniejszonym przeżyciem całkowitym (HR=3,39; 95%CI: 1,56-7,37; p=0,002) i przeżyciem wolnym od nawrotu (HR=2,36; 95%CI: 1,3-4,3; p=0,005) w porównaniu z niesprawną naprawą niesparowanych zasad (dMMR).¹ Status dMMR wykazał również silną skłonność do nawrotu miejscowego w przeciwieństwie do nawrotu odległego.²

Wzorce nawrotów

Dominującym wzorcem nawrotu w raku jelita cienkiego jest nawrót odległy (DR), przy czym nawrót otrzewnowy jest częstszy w przypadku pierwotnych lokalizacji w jelicie czczym i krętym.¹ Jest to istotna informacja dla planowania strategii obserwacji po leczeniu.²

Różnice demograficzne w rokowaniu

Przeżywalność 5-letnia w raku jelita cienkiego różni się w zależności od wieku, płci i statusu socjoekonomicznego:¹

Wiek: Około 73,5% osób w wieku 15-44 lat przeżywa 5 lat lub dłużej, w porównaniu z około 38,8% osób zdiagnozowanych w wieku 75-99 lat
Płeć: Przeżywalność 5-letnia jest podobna u kobiet i mężczyzn
Status socjoekonomiczny: Ponad połowa osób z najmniej (54,3%) i najbardziej (51,8%) ubogich grup przeżywa 5 lat lub dłużej

Niezależne czynniki prognostyczne

W analizie wieloczynnikowej zidentyfikowano niezależne czynniki prognostyczne dla przeżycia w raku jelita cienkiego:¹²

Dla przeżycia wolnego od nawrotu (RFS): zajęcie węzłów chłonnych, inwazja naczyń limfatycznych, stopień histologiczny i rasa
Dla przeżycia całkowitego (OS): rasa, stadium zaawansowania i stopień histologiczny
Dodatkowo, dla OS: inwazja okołonerwowa

Słabe zróżnicowanie histologiczne, zajęcie węzłów chłonnych, inna rasa niż czarna, inwazja okołonerwowa (tylko dla OS) oraz inwazja naczyń limfatycznych (tylko dla RFS) są niezależnymi czynnikami prognostycznymi gorszego przeżycia w gruczolakoraku jelita cienkiego.⁴

Znaczenie wczesnej diagnozy

Ogólnie rzecz biorąc, im wcześniej rak jelita cienkiego zostanie zdiagnozowany i leczony, tym lepsze rokowanie.¹ Mimo postępów w metodach diagnostycznych, badania nie wykazały poprawy w zakresie wcześniejszej diagnozy raka jelita cienkiego w ciągu ostatnich trzech dekad.² Podkreśla to potrzebę zwiększenia świadomości diagnostycznej, aby poprawić czas do diagnozy dla pacjentów z rakiem jelita cienkiego.³

Indywidualne podejście do rokowania

Pacjenci z rakiem powinni omówić swoje rokowanie z lekarzem prowadzącym. Rokowanie zależy od wielu czynników, w tym:¹²

Historii medycznej pacjenta
Typu nowotworu
Stadium zaawansowania
Charakterystyki nowotworu
Wybranych metod leczenia
Odpowiedzi na leczenie

Tylko lekarz znający wszystkie te czynniki może połączyć te informacje ze statystykami przeżycia, aby określić indywidualne rokowanie.⁴⁵

Przyszłość prognozowania raka jelita cienkiego

Badania genomiczne oferują nowe możliwości w poszukiwaniu biomarkerów przewidywania rokowania w rakach jelita cienkiego. Analiza genomiczna raka może być przydatna w poszukiwaniu biomarkerów predykcji rokowania w nowotworach jelita cienkiego.¹ Wyniki tych badań dostarczają nowych informacji dla rozwoju innowacyjnych metod terapeutycznych, takich jak leki ukierunkowane molekularnie dla nowotworów jelita cienkiego.²

Ponadto, dokładna analiza patologiczna i testowanie naprawy niesparowanych zasad mają kluczowe znaczenie dla określenia rokowania i planowania leczenia.¹ Pacjenci z różnymi typami histologicznymi powinni być leczeni różnymi strategiami terapeutycznymi, aby uzyskać optymalne przeżycie.²

Kolejne rozdziały

Zapraszamy do dalszego czytania naszego leksykonu.

Wybierz kolejny rozdział z menu poniżej, aby otworzyć nową podstronę kompedium wiedzy i uzyskać szczegółowe informację o leku, substancji lub chorobie.

Materiały źródłowe

#1 Prognosis and survival for small intestine cancer | Canadian Cancer Society
https://cancer.ca/en/cancer-information/cancer-types/small-intestine/prognosis-and-survival
If you have small intestine cancer, you may have questions about your prognosis. A prognosis is the doctors best estimate of how cancer will affect a person and how it will respond to treatment. Prognosis and survival depend on many factors. Only a doctor familiar with your health history, the type, stage and characteristics of the cancer, the treatments chosen and the response to treatment can put all of this information together with survival statistics to arrive at a prognosis. […] The stage is the most important prognostic factor for small intestine cancer. The lower the stage at diagnosis, the better the prognosis. Tumours that are only in the small intestine have a more favourable prognosis than those that have grown through the wall of the small intestine, have spread to lymph nodes or have spread to other organs farther from the small intestine (called distant metastases).
#1 Survival statistics for small intestine cancer | Canadian Cancer Society
https://cancer.ca/en/cancer-information/cancer-types/small-intestine/prognosis-and-survival/survival-statistics
Survival statistics for small intestine cancer are very general estimates and must be interpreted very carefully. Because these statistics are based on the experience of groups of people, they cannot be used to predict a particular persons chances of survival. […] In Canada, a 5-year net survival statistic is reported for small intestine cancer. The 5-year net survival for small intestine cancer is 54%. This means that about 54% of people diagnosed with small intestine cancer will survive for at least 5 years. […] Survival varies with each stage and type of small intestine cancer, as well as whether or not it can be completely removed with surgery (is resectable). The following factors can also affect survival for small intestine cancer. Generally, the earlier small intestine cancer is diagnosed and treated, the better the outcome.
#1 Prognosis and survival for small intestine cancer | Canadian Cancer Society
https://cancer.ca/en/cancer-information/cancer-types/small-intestine/prognosis-and-survival
Tumours that can be completely removed with surgery have a better prognosis than tumours that cant be completely removed. […] If 8 or more lymph nodes are surgically removed, there is less risk that the cancer will recur than if 7 or fewer lymph nodes are removed. So people who have 8 or more lymph nodes removed have a better prognosis. […] The prognosis is different for different types of small intestine cancer. In general, the types of small intestine cancer with the most favourable to least favourable prognosis are: neuroendocrine tumours (NETs), lymphoma (follicular lymphoma has the best prognosis of all small intestine lymphomas), gastrointestinal stromal tumours (GISTs), soft tissue sarcoma, adenocarcinoma.
#1 Frequency, prognosis and treatment modalities of newly diagnosed small bowel cancer with liver metastases | BMC Gastroenterology | Full Text
https://bmcgastroenterol.biomedcentral.com/articles/10.1186/s12876-020-01487-6
Population-based analysis for the liver metastases of small bowel cancer is currently lacking. This study aimed to analyze the frequency, prognosis and treatment modalities for newly diagnosed small bowel cancer patients with liver metastases. […] Patients with liver metastases had significant poorer survival (P0.001) than those without liver metastases. […] The combined predictor had a good ability to predict the presence of liver metastases. […] In addition, those patients with different histologic types should be treated with distinct therapeutic strategy for obtaining optimal survival. […] The presence of liver metastases served as an important predictor for worse prognosis of small bowel cancer […] Consistent with previous study, our result demonstrated that patients with liver metastases had a poor survival when compared with those without liver metastases.
#1 Genomic analysis for the prediction of prognosis in small-bowel cancer | PLOS One
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0241454
The current understanding of clinicopathological features and genomic variants of small-bowel cancer is limited, in part due to the rarity of the disease. However, understanding of these factors is necessary for the development of novel therapeutic agents for small-bowel cancer. Thus, we aimed to identify the clinicopathological features and genomic variants associated with its prognosis and recurrence. […] Overall survival and disease-specific survival of patients with tumor mutational burden (TMB) 10 mutations/Mb (n = 17) were significantly better than those of patients with TMB 10 mutations/Mb (n = 6). Additionally, patients with a mutant SMAD4 had poorer recurrence-free survival than those with wild-type SMAD4. Our results suggested that TMB and SMAD4 mutations were associated with the prognosis of small-bowel cancer patients. Thus, cancer genomic analysis could be useful in the search for biomarkers of prognosis prediction in small-bowel cancers.
#1 Natural history and prognostic factors for localised small bowel adenocarcinoma
https://pmc.ncbi.nlm.nih.gov/articles/PMC7668374/
Median OS was 57.5 months and median follow-up was 40 months. […] The 5-year Kaplan-Meier estimates for OS of patients with pathologic stage I, II and III were 79%, 58% and 38%, respectively (p<0.001). [...] We also considered a different set of 10 covariates in building a multivariate model for OS. Race, stage and histological grade were independent predictors of OS. [...] In univariate analysis, proficient mismatch repair (pMMR) was associated with decreased OS (HR=3.39; 95%CI: 1.56-7.37; p=0.002) and RFS (HR=2.36; 95%CI: 1.3-4.3; p=0.005) when compared with dMMR. [...] In this large retrospective cohort study over four decades, we summarise the prognostic factors associated with resected localised SBA. [...] Multivariate analysis suggests that lymph node involvement, poor histological differentiation, non-black race, perineural invasion (OS only) and lymphovascular invasion (RFS only) are independent predictors for poor survival in SBA.
#1 Natural history and prognostic factors for localised small bowel adenocarcinoma
https://pmc.ncbi.nlm.nih.gov/articles/PMC7668374/
The primary recurrence pattern was DR with peritoneal recurrence more common for jejunal and ileal primary sites. […] This report demonstrates the need for continued focus on diagnostic awareness to help improve the time to diagnosis for patients with SBA, the distant recurrence predilection, the importance for thorough pathological analysis and the importance of mismatch repair testing.
#1 Small intestine cancer statistics | Cancer Research UK
https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/small-intestine-cancer
More than half (53.0%) of people diagnosed with small intestine cancer in England survive their disease for five years or more, it is predicted (2016-2020). […] Small intestine cancer five-year survival in England is similar in females and males (2016-2020). […] Around three-quarters (73.5%) of people in England diagnosed with small intestine cancer aged 15-44 survive their disease for five years or more, compared with around 4 in 10 (38.8%) people diagnosed aged 75-99 (2016-2020). […] More than half of people in England diagnosed with small intestine cancer in the least deprived (54.3%) and most deprived (51.8%) groups survive their disease for five years or more (2015-2019). […] Five-year relative survival for small intestine cancer is below or similar to the European average in the UK. Further details on cancer survival in Europe can be found on the EUROCARE website. […] For small intestine cancer, like other cancer sites, survival trends reflect a combination of changes in treatment and stage distribution. These factors themselves can vary by age, sex and deprivation.
#1 Natural history and prognostic factors for localised small bowel adenocarcinoma
https://pmc.ncbi.nlm.nih.gov/articles/PMC7668374/
Small bowel adenocarcinoma (SBA) is a rare malignancy with limited evidence regarding outcomes after curative resection of localised disease. We aimed to evaluate presentation and prognostic factors affecting overall survival (OS), relapse-free survival (RFS) and recurrence of SBA. […] In multivariate analysis, lymph node involvement, lymphovascular invasion, histologic grade and race were independent predictors of RFS, while race, stage and histologic grade were independent predictors of OS. […] The predominant pattern of disease recurrence was distant across all SBA locations, but dMMR status demonstrated a robust predilection for LR as opposed to DR. […] Despite advances in diagnostic modalities, this study did not show any improvement in earlier diagnosis of SBA over the course of the past three decades.
#1 Survival statistics for small intestine cancer | Canadian Cancer Society
https://cancer.ca/en/cancer-information/cancer-types/small-intestine/prognosis-and-survival/survival-statistics
The survival statistics below are for the various stages of adenocarcinomas of the small intestine, the most common type of small intestine cancer. The 5-year survival rate is the percentage of people who are alive at least 5 years after their cancer diagnosis. But people with this type of cancer may live much longer than 5 years. […] People with cancer should talk to their doctor about their prognosis. Prognosis depends on many factors, including: a persons medical history, type of cancer, stage, characteristics of the cancer, treatments chosen, response to treatment. Only a doctor familiar with these factors can put all of this information together with survival statistics to arrive at a prognosis.
#2 Survival Rates for Small Intestine Cancer (Adenocarcinoma) | American Cancer Society
https://www.cancer.org/cancer/types/small-intestine-cancer/detection-diagnosis-staging/survival-rates.html
Survival rates can give you an idea of what percentage of people with the same type and stage of cancer are still alive a certain amount of time (usually 5 years) after they were diagnosed. […] They do not apply later on if the cancer grows, spreads, or comes back after treatment. […] People now being diagnosed with small intestine cancer may have a better outlook than these numbers show.
#2 Small intestine cancer statistics | Cancer Research UK
https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/small-intestine-cancer
More than half (53.0%) of people diagnosed with small intestine cancer in England survive their disease for five years or more, it is predicted (2016-2020). […] Small intestine cancer five-year survival in England is similar in females and males (2016-2020). […] Around three-quarters (73.5%) of people in England diagnosed with small intestine cancer aged 15-44 survive their disease for five years or more, compared with around 4 in 10 (38.8%) people diagnosed aged 75-99 (2016-2020). […] More than half of people in England diagnosed with small intestine cancer in the least deprived (54.3%) and most deprived (51.8%) groups survive their disease for five years or more (2015-2019). […] Five-year relative survival for small intestine cancer is below or similar to the European average in the UK. Further details on cancer survival in Europe can be found on the EUROCARE website. […] For small intestine cancer, like other cancer sites, survival trends reflect a combination of changes in treatment and stage distribution. These factors themselves can vary by age, sex and deprivation.
#2 Small Intestine Cancer: Symptoms, Causes, Prognosis & Treatment
https://my.clevelandclinic.org/health/diseases/6225-small-intestine-cancer
Your prognosis depends on numerous factors, including the cancer type, its stage and where the tumor started in your small intestine. […] The survival rate varies depending on the type of small intestine cancer, the stage and where the tumor started in your small intestine. For instance, 65% of people diagnosed with early-stage adenocarcinomas are alive five years later. The survival rate in later stages is much less at 4%. Early-stage carcinoid tumors have a five-year survival rate of 95%, while later-stage cancers have a survival rate of 42%. […] Ask your healthcare provider about how the characteristics of your cancer will affect your prognosis.
#2 Prognosis and survival for small intestine cancer | Canadian Cancer Society
https://cancer.ca/en/cancer-information/cancer-types/small-intestine/prognosis-and-survival
Tumours that can be completely removed with surgery have a better prognosis than tumours that cant be completely removed. […] If 8 or more lymph nodes are surgically removed, there is less risk that the cancer will recur than if 7 or fewer lymph nodes are removed. So people who have 8 or more lymph nodes removed have a better prognosis. […] The prognosis is different for different types of small intestine cancer. In general, the types of small intestine cancer with the most favourable to least favourable prognosis are: neuroendocrine tumours (NETs), lymphoma (follicular lymphoma has the best prognosis of all small intestine lymphomas), gastrointestinal stromal tumours (GISTs), soft tissue sarcoma, adenocarcinoma.
#2 Natural history and prognostic factors for localised small bowel adenocarcinoma
https://pmc.ncbi.nlm.nih.gov/articles/PMC7668374/
Median OS was 57.5 months and median follow-up was 40 months. […] The 5-year Kaplan-Meier estimates for OS of patients with pathologic stage I, II and III were 79%, 58% and 38%, respectively (p<0.001). [...] We also considered a different set of 10 covariates in building a multivariate model for OS. Race, stage and histological grade were independent predictors of OS. [...] In univariate analysis, proficient mismatch repair (pMMR) was associated with decreased OS (HR=3.39; 95%CI: 1.56-7.37; p=0.002) and RFS (HR=2.36; 95%CI: 1.3-4.3; p=0.005) when compared with dMMR. [...] In this large retrospective cohort study over four decades, we summarise the prognostic factors associated with resected localised SBA. [...] Multivariate analysis suggests that lymph node involvement, poor histological differentiation, non-black race, perineural invasion (OS only) and lymphovascular invasion (RFS only) are independent predictors for poor survival in SBA.
#2 Frequency, prognosis and treatment modalities of newly diagnosed small bowel cancer with liver metastases | BMC Gastroenterology | Full Text
https://bmcgastroenterol.biomedcentral.com/articles/10.1186/s12876-020-01487-6
In summary, this study provided investigation of the frequency for liver metastases of small bowel cancer at initial diagnosis. Primary tumor presented with lower part of small intestine, poor tumor grade, larger tumor size, later N staging, and presence of more extrahepatic metastatic sites had increased propensity of developing liver metastases. Patients with liver metastases had significant poorer survival than those without liver metastases.
#2 Genomic analysis for the prediction of prognosis in small-bowel cancer | PLOS One
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0241454
TMB status was strongly associated with prognosis in patients with small-bowel cancer. TMB is a measurement of somatic mutations per Mb of DNA carried by tumor cells. […] Finally, the RFS of patients with small-bowel cancers containing SMAD4 mutations was significantly poorer than that of patients without SMAD4 mutations. […] Our study revealed the MMR status and genetic variants of small-bowel cancer in a Japanese population. […] In conclusion, TMB levels correlated with tumor prognosis and SMAD4 mutations were associated with recurrence after R0 resection in patients with small-bowel cancer. Our results provide novel insights for the development of novel therapeutic approaches such as molecularly targeted drugs for small-bowel cancers.
#2 Natural history and prognostic factors for localised small bowel adenocarcinoma
https://pmc.ncbi.nlm.nih.gov/articles/PMC7668374/
Small bowel adenocarcinoma (SBA) is a rare malignancy with limited evidence regarding outcomes after curative resection of localised disease. We aimed to evaluate presentation and prognostic factors affecting overall survival (OS), relapse-free survival (RFS) and recurrence of SBA. […] In multivariate analysis, lymph node involvement, lymphovascular invasion, histologic grade and race were independent predictors of RFS, while race, stage and histologic grade were independent predictors of OS. […] The predominant pattern of disease recurrence was distant across all SBA locations, but dMMR status demonstrated a robust predilection for LR as opposed to DR. […] Despite advances in diagnostic modalities, this study did not show any improvement in earlier diagnosis of SBA over the course of the past three decades.
#2 Natural history and prognostic factors for localised small bowel adenocarcinoma
https://pmc.ncbi.nlm.nih.gov/articles/PMC7668374/
The primary recurrence pattern was DR with peritoneal recurrence more common for jejunal and ileal primary sites. […] This report demonstrates the need for continued focus on diagnostic awareness to help improve the time to diagnosis for patients with SBA, the distant recurrence predilection, the importance for thorough pathological analysis and the importance of mismatch repair testing.
#2 Frequency, prognosis and treatment modalities of newly diagnosed small bowel cancer with liver metastases | BMC Gastroenterology | Full Text
https://bmcgastroenterol.biomedcentral.com/articles/10.1186/s12876-020-01487-6
Population-based analysis for the liver metastases of small bowel cancer is currently lacking. This study aimed to analyze the frequency, prognosis and treatment modalities for newly diagnosed small bowel cancer patients with liver metastases. […] Patients with liver metastases had significant poorer survival (P0.001) than those without liver metastases. […] The combined predictor had a good ability to predict the presence of liver metastases. […] In addition, those patients with different histologic types should be treated with distinct therapeutic strategy for obtaining optimal survival. […] The presence of liver metastases served as an important predictor for worse prognosis of small bowel cancer […] Consistent with previous study, our result demonstrated that patients with liver metastases had a poor survival when compared with those without liver metastases.
#3 Survival statistics for small intestine cancer | Canadian Cancer Society
https://cancer.ca/en/cancer-information/cancer-types/small-intestine/prognosis-and-survival/survival-statistics
Survival statistics for small intestine cancer are very general estimates and must be interpreted very carefully. Because these statistics are based on the experience of groups of people, they cannot be used to predict a particular persons chances of survival. […] In Canada, a 5-year net survival statistic is reported for small intestine cancer. The 5-year net survival for small intestine cancer is 54%. This means that about 54% of people diagnosed with small intestine cancer will survive for at least 5 years. […] Survival varies with each stage and type of small intestine cancer, as well as whether or not it can be completely removed with surgery (is resectable). The following factors can also affect survival for small intestine cancer. Generally, the earlier small intestine cancer is diagnosed and treated, the better the outcome.
#3 Survival statistics for small intestine cancer | Canadian Cancer Society
https://cancer.ca/en/cancer-information/cancer-types/small-intestine/prognosis-and-survival/survival-statistics
The survival statistics below are for the various stages of adenocarcinomas of the small intestine, the most common type of small intestine cancer. The 5-year survival rate is the percentage of people who are alive at least 5 years after their cancer diagnosis. But people with this type of cancer may live much longer than 5 years. […] People with cancer should talk to their doctor about their prognosis. Prognosis depends on many factors, including: a persons medical history, type of cancer, stage, characteristics of the cancer, treatments chosen, response to treatment. Only a doctor familiar with these factors can put all of this information together with survival statistics to arrive at a prognosis.
#3 Small Intestine Cancer: Symptoms, Causes, Prognosis & Treatment
https://my.clevelandclinic.org/health/diseases/6225-small-intestine-cancer
Your prognosis depends on numerous factors, including the cancer type, its stage and where the tumor started in your small intestine. […] The survival rate varies depending on the type of small intestine cancer, the stage and where the tumor started in your small intestine. For instance, 65% of people diagnosed with early-stage adenocarcinomas are alive five years later. The survival rate in later stages is much less at 4%. Early-stage carcinoid tumors have a five-year survival rate of 95%, while later-stage cancers have a survival rate of 42%. […] Ask your healthcare provider about how the characteristics of your cancer will affect your prognosis.
#3 Frequency, prognosis and treatment modalities of newly diagnosed small bowel cancer with liver metastases | BMC Gastroenterology | Full Text
https://bmcgastroenterol.biomedcentral.com/articles/10.1186/s12876-020-01487-6
In summary, this study provided investigation of the frequency for liver metastases of small bowel cancer at initial diagnosis. Primary tumor presented with lower part of small intestine, poor tumor grade, larger tumor size, later N staging, and presence of more extrahepatic metastatic sites had increased propensity of developing liver metastases. Patients with liver metastases had significant poorer survival than those without liver metastases.
#3 Natural history and prognostic factors for localised small bowel adenocarcinoma
https://pmc.ncbi.nlm.nih.gov/articles/PMC7668374/
Median OS was 57.5 months and median follow-up was 40 months. […] The 5-year Kaplan-Meier estimates for OS of patients with pathologic stage I, II and III were 79%, 58% and 38%, respectively (p<0.001). [...] We also considered a different set of 10 covariates in building a multivariate model for OS. Race, stage and histological grade were independent predictors of OS. [...] In univariate analysis, proficient mismatch repair (pMMR) was associated with decreased OS (HR=3.39; 95%CI: 1.56-7.37; p=0.002) and RFS (HR=2.36; 95%CI: 1.3-4.3; p=0.005) when compared with dMMR. [...] In this large retrospective cohort study over four decades, we summarise the prognostic factors associated with resected localised SBA. [...] Multivariate analysis suggests that lymph node involvement, poor histological differentiation, non-black race, perineural invasion (OS only) and lymphovascular invasion (RFS only) are independent predictors for poor survival in SBA.
#3 Natural history and prognostic factors for localised small bowel adenocarcinoma
https://pmc.ncbi.nlm.nih.gov/articles/PMC7668374/
The primary recurrence pattern was DR with peritoneal recurrence more common for jejunal and ileal primary sites. […] This report demonstrates the need for continued focus on diagnostic awareness to help improve the time to diagnosis for patients with SBA, the distant recurrence predilection, the importance for thorough pathological analysis and the importance of mismatch repair testing.
#4 Survival statistics for small intestine cancer | Canadian Cancer Society
https://cancer.ca/en/cancer-information/cancer-types/small-intestine/prognosis-and-survival/survival-statistics
Survival statistics for small intestine cancer are very general estimates and must be interpreted very carefully. Because these statistics are based on the experience of groups of people, they cannot be used to predict a particular persons chances of survival. […] In Canada, a 5-year net survival statistic is reported for small intestine cancer. The 5-year net survival for small intestine cancer is 54%. This means that about 54% of people diagnosed with small intestine cancer will survive for at least 5 years. […] Survival varies with each stage and type of small intestine cancer, as well as whether or not it can be completely removed with surgery (is resectable). The following factors can also affect survival for small intestine cancer. Generally, the earlier small intestine cancer is diagnosed and treated, the better the outcome.
#4 Natural history and prognostic factors for localised small bowel adenocarcinoma
https://pmc.ncbi.nlm.nih.gov/articles/PMC7668374/
Median OS was 57.5 months and median follow-up was 40 months. […] The 5-year Kaplan-Meier estimates for OS of patients with pathologic stage I, II and III were 79%, 58% and 38%, respectively (p<0.001). [...] We also considered a different set of 10 covariates in building a multivariate model for OS. Race, stage and histological grade were independent predictors of OS. [...] In univariate analysis, proficient mismatch repair (pMMR) was associated with decreased OS (HR=3.39; 95%CI: 1.56-7.37; p=0.002) and RFS (HR=2.36; 95%CI: 1.3-4.3; p=0.005) when compared with dMMR. [...] In this large retrospective cohort study over four decades, we summarise the prognostic factors associated with resected localised SBA. [...] Multivariate analysis suggests that lymph node involvement, poor histological differentiation, non-black race, perineural invasion (OS only) and lymphovascular invasion (RFS only) are independent predictors for poor survival in SBA.
#4 Survival statistics for small intestine cancer | Canadian Cancer Society
https://cancer.ca/en/cancer-information/cancer-types/small-intestine/prognosis-and-survival/survival-statistics
The survival statistics below are for the various stages of adenocarcinomas of the small intestine, the most common type of small intestine cancer. The 5-year survival rate is the percentage of people who are alive at least 5 years after their cancer diagnosis. But people with this type of cancer may live much longer than 5 years. […] People with cancer should talk to their doctor about their prognosis. Prognosis depends on many factors, including: a persons medical history, type of cancer, stage, characteristics of the cancer, treatments chosen, response to treatment. Only a doctor familiar with these factors can put all of this information together with survival statistics to arrive at a prognosis.
#5 Survival Rates for Small Intestine Cancer (Adenocarcinoma) | American Cancer Society
https://www.cancer.org/cancer/types/small-intestine-cancer/detection-diagnosis-staging/survival-rates.html
Survival rates can give you an idea of what percentage of people with the same type and stage of cancer are still alive a certain amount of time (usually 5 years) after they were diagnosed. […] They do not apply later on if the cancer grows, spreads, or comes back after treatment. […] People now being diagnosed with small intestine cancer may have a better outlook than these numbers show.
#5 Prognosis and survival for small intestine cancer | Canadian Cancer Society
https://cancer.ca/en/cancer-information/cancer-types/small-intestine/prognosis-and-survival
If you have small intestine cancer, you may have questions about your prognosis. A prognosis is the doctors best estimate of how cancer will affect a person and how it will respond to treatment. Prognosis and survival depend on many factors. Only a doctor familiar with your health history, the type, stage and characteristics of the cancer, the treatments chosen and the response to treatment can put all of this information together with survival statistics to arrive at a prognosis. […] The stage is the most important prognostic factor for small intestine cancer. The lower the stage at diagnosis, the better the prognosis. Tumours that are only in the small intestine have a more favourable prognosis than those that have grown through the wall of the small intestine, have spread to lymph nodes or have spread to other organs farther from the small intestine (called distant metastases).