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©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Mar 15, 2020; 12(3): 347-357
Published online Mar 15, 2020. doi: 10.4251/wjgo.v12.i3.347
Clinical outcomes of patients with duodenal adenocarcinoma and intestinal-type papilla of Vater adenocarcinoma
Laura L Meijer, Marin Strijker, Jacob K de Bakker, Jurgen GJ Toennaer, Barbara M Zonderhuis, Hans J van der Vliet, Hanneke Wilmink, Joanne Verheij, Freek Daams, Olivier R Busch, Nicole CT van Grieken, Marc G Besselink, Geert Kazemier
Laura L Meijer, Jacob K de Bakker, Jurgen GJ Toennaer, Barbara M Zonderhuis, Freek Daams, Geert Kazemier, Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, VU University Amsterdam, Amsterdam, Noord-Holland 1081HV, The Netherlands
Marin Strijker, Olivier R Busch, Marc G Besselink, Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, Noord-Holland 1105AZ, The Netherlands
Hans J van der Vliet, Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam UMC, VU University Amsterdam, Amsterdam, Noord-Holland 1081HV, The Netherlands
Hanneke Wilmink, Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam Amsterdam, Noord-Holland 1105AZ, The Netherlands
Joanne Verheij, Department of Pathology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam Amsterdam, Noord-Holland 1105AZ, The Netherlands
Nicole CT van Grieken, Department of Pathology, Cancer Center Amsterdam, Amsterdam UMC, VU University Amsterdam Noord-Holland 1081HV, The Netherlands
Author contributions: Meijer LL, Zonderhuis BM, Daams F, van Grieken NCT, Besselink MG and Kazemier G designed the research and study concept; Meijer LL, Strijker M, de Bakker JK, Toennaer JGJ, Verheij J and van Grieken NCT performed the research and data collection; Meijer LL, Strijker M, de Bakker JK, Toennaer JGJ and Kazemier G performed the statistical analysis; Meijer L, Strijker M, de Bakker JK, Zonderhuis BM, van der Vliet HJ, Wilmink H, Verheij J, Daams F, Busch OR, van Grieken NCT, Besselink MG and Kazemier G performed the data interpretation; Meijer LL, Strijker J, de Bakker JK and GK wrote the manuscript draft; Toennaer JGJ, Zonderhuis BM, van der Vliet HJ, Wilmink H, Verheij J, Daams F, Busch OR, van Grieken NCT, Besselink MG and Kazemier G reviewed and revised the manuscript; Strijker M and de Bakker JK contributed equally to this work.
Supported by the Bennink Foundation, No. 2002262; the Cancer Center Amsterdam Foundation.
Institutional review board statement: This study was reviewed and approved by the VUmc Amsterdam Institutional Review Board.
Conflict-of-interest statement: There are no conflicts of interest to report.
STROBE statement: This study was prepared and revised according to the STROBE statement and checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Geert Kazemier, FEBS, MD, PhD, Professor, Professor of Hepatobiliary Surgery and Transplantation, Director of Digestive and Oncologic Surgery, Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, VU University Amsterdam, De Boelelaan 1117, Amsterdam 1081HV, The Netherlands.
g.kazemier@amsterdamumc.nl
Received: October 21, 2019
Peer-review started: October 21, 2019
First decision: December 5, 2019
Revised: January 4, 2020
Accepted: January 19, 2020
Article in press: January 19, 2020
Published online: March 15, 2020
Processing time: 142 Days and 16.1 Hours
BACKGROUND
Duodenal adenocarcinoma (DA) and intestinal-type papilla of Vater adenocarcinoma (it-PVA) are rare malignancies of the gastrointestinal tract. Current therapeutic options are translated nowadays from treatment strategies for patients with colorectal cancer due to histopathological similarities.
AIM
To retrospectively investigate the clinical outcome of patients with DA and it-PVA.
METHODS
All patients with DA and it-PVA diagnosed between 2000 and 2017 were included at two academic centers in the Netherlands. All patients with histopathologically-confirmed DA or it-PVA were eligible for inclusion. Clinical outcome was compared between DA and it-PVA per disease stage. In the subgroup of stage IV disease, survival after local treatment of oligometastases was compared with systemic therapy or supportive care.
RESULTS
In total, 155 patients with DA and it-PVA were included. Patients with it-PVA more often presented with stage I disease, while DA was more often diagnosed at stage IV (P < 0.001). Of all patients, 79% were treated with curative intent. The median survival was 39 mo, and no difference in survival was found for patients with DA and it-PVA after stratification for disease stage. Seven (23%) of 31 patients with synchronous stage IV disease underwent resection of the primary tumor, combined with local treatment of oligometastases. Local treatment of metastases was associated with an overall survival of 37 mo, compared to 14 and 6 mo for systemic therapy and supportive care, respectively.
CONCLUSION
Survival of patients with DA and it-PVA is comparable per disease stage. These results suggest a potential benefit for local treatment strategies in selected patients with oligometastases, although additional prospective studies are needed.
Core tip: This study demonstrates the clinical outcome for duodenal adenocarcinoma and intestinal-type papilla of Vater adenocarcinoma, which are rare tumor types of the gastrointestinal tract. The overall survival is comparable per disease stage, resulting in a median survival of 39 mo. Most patients (79%) are treated with curative intent by surgical resection of the tumor. For patients with metastatic disease, local treatment of metastases was associated with a better overall survival compared to systemic treatment or supportive care. Future prospective studies are needed to confirm this survival benefit.
