T. Oyasiji1, W. Tan2, N. Wilkinson3 1Karmanos Cancer Institute,Surgical Oncology,Flint, MI, USA 2Roswell Park Cancer Institute,Biostatistics,Buffalo, NY, USA 3Kalispel Regional Medical Center,Surgical Oncology,Kalispel, MONTANA, USA
Introduction: Duodenal adenocarcinoma (DA) is rare. We sought to evaluate trends and predictors of survival outcomes from analysis of a large national database.
Methods: We identified all DA patients between 1988 and 2011 using the SEER database. Patients were grouped into two 12-year periods, 1988-1999 (group 1) and 2000-2011 (group 2). Each group was subdivided into those who had surgery for treatment of DA and those who did not. Overall survival (OS) and disease -specific survival (DSS) were determined for the groups and subgroups, and compared to identify trend in survival outcomes for the two periods. Survival analysis was done using Kaplan Meier method and Cox proportional hazards model was utilized for univariate and multivariate analyses.
Results: Of 3183 patients, 1411(44.3%) were treated with surgery. 51% were males while 75% were Caucasians. 76% of patients were in Group 2. Mean age, gender and race distribution were comparable for both groups (p >0.05). Median OS was 8 months for both groups (p=0.5). Median DSS was 11.0 months for both groups (p=0.58). For the two groups, median OS and median DSS were significantly better for those treated with surgery compared to those who were not treated with surgery ( Group 1- OS 21 vs 3 months, DSS 27 versus 4 months; Group 2- OS 25 vs 4 months , DSS 33 vs 5 months; p values<0.001). The surgery subgroup for Group 2 had better OS and DSS compared to Group 1 surgery subgroup, with a trend toward significance (OS 25 vs 21 months and DSS 33 versus 27 months, p values=0.06). On multivariate analysis, advanced age, AJCC stage and T stage were independent negative predictors of OS and DSS while treatment with surgery was an independent favorable predictor of OS and DSS.
Conclusion: There is a trend for improved OS and DSS for DA patients treated with surgery between 2000 & 2011 compared to those treated with surgery between 1988 & 1999. Patients treated with surgery have significantly better OS and DSS than those who did not undergo surgery, regardless of time period. Early detection (when disease is resectable) and surgical treatment might translate to improved survival outcomes.