XXXX : a study of 37 cases with emphasis on histologic prognostic factors.

@entity1 @entity417 @entity5 @entity30 @entity1744 @entity3 @entity490 @entity14 @entity1412 @entity420
PURPOSE: Primary small-bowel @entity420 is uncommon. There are few large studies that have evaluated the prognostic impact of clinical and pathologic parameters. The purpose of this study was to perform a comprehensive analysis of the Cleveland Clinic experience with small-bowel @entity420 , with emphasis on histopathologic parameters as prognostic indicators. METHODS: Thirty-seven cases of @entity420 resected at the Cleveland Clinic between 1978 and 1999 were retrospectively studied. @entity3 and those arising from the biliary system were excluded from analysis. Clinical and pathologic data were recorded and their impact on prognosis was evaluated by either Kaplan-Meier or Cox proportional hazards analysis. RESULTS: The cohort included 25 males, and the age range was 24 to 82 (mean, 56) years. @entity5 location was duodenum (18), jejunum (10), ileum (2), and site not specified (7). @entity1 most frequently presented with @entity490 (48 percent), @entity417 (39 percent) and @entity1744 (33 percent). Underlying conditions included @entity30 (4) and @entity1412 (2). Overall survival was 52 and 47 percent at 5 and 10 years, respectively, with a mean follow-up of 50.5 (range, 0.5-184) months for all @entity1 . Features found to be negative prognostic factors for survival were positive surgical margins (P < 0.001), extramural venous spread (P < 0.001), lymph node @entity3 (P = 0.038), poor @entity5 differentiation (P = 0.015), depth of @entity5 invasion (P = 0.023), and history of @entity30 (P < 0.001). Age, gender, @entity5 size, growth pattern, lymphocytic host response, and adjuvant therapy did not affect survival. CONCLUSIONS: Pathologic features, including positive surgical margins, extramural venous spread, positive lymph nodes, poor @entity5 differentiation, depth of @entity5 invasion, and history of @entity30 , are of major prognostic significance in small-bowel @entity420 . Although many of these prognostic features are similar to the ones used for @entity14 , they are easily applicable and reproducible for small-bowel @entity420 . This is important considering the often dismal prognosis of small-bowel @entity420 .
