Adjuvant chemotherapy benefit according to T and N stage in small bowel adenocarcinoma: a large retrospective multicenter study

Aziz Zaanan (1, 2, 3) , Julie Henriques (4) , Anthony Turpin (5) , Sylvain Manfredi (6) , Romain Coriat (7) , Eric Terrebonne (8) , Jean‐louis Legoux (9) , Thomas Walter (10) , Christophe Locher , Olivier Dubreuil (11) , Simon Pernot (12) , Chloé Vernet (13) , Olivier Bouché (14) , Vincent Hautefeuille , Johan Gagnière (15) , Thierry Lecomte (16) , David Tougeron (17) , Thomas Grainville (18, 19) , Dewi Vernerey (4) , Pauline Afchain , Thomas Aparicio (1, 20)

1 UPCité - Université Paris Cité
2 HEGP - Hôpital Européen Georges Pompidou [APHP]
3 Cancer Research and Personalized Medicine - CARPEM [Paris]
4 RIGHT - Interactions hôte-greffon-tumeur, ingénierie cellulaire et génique - UFC (UMR INSERM 1098)
5 CHRU Lille - Centre Hospitalier Régional Universitaire [CHU Lille]
6 LNC - Lipides - Nutrition - Cancer [Dijon - U1231]
7 Hôpital Cochin [AP-HP]
8 CIC Bordeaux
9 CHRO - Centre Hospitalier Régional d'Orléans
10 HCL - Hospices Civils de Lyon
11 Groupe Hospitalier Diaconesses Croix Saint-Simon
12 Institut Bergonié [Bordeaux]
13 Hôpital privé Jean Mermoz [Lyon]
14 Hôpital universitaire Robert Debré [Reims]
15 M2iSH - Microbes, Intestin, Inflammation et Susceptibilité de l'Hôte
16 N2Cox - Niche, Nutrition, Cancer et métabolisme oxydatif
17 CHU de Poitiers [La Milétrie] - Centre hospitalier universitaire de Poitiers = Poitiers University Hospital
18 Centre Hospitalier Universitaire de Rennes [CHU Rennes] = Rennes University Hospital [Ponchaillou]
19 OSS - Oncogenesis, Stress, Signaling
20 AP-HP - Hopital Saint-Louis [AP-HP]

BACKGROUND: Small bowel adenocarcinoma is a rare cancer, and the role of adjuvant chemotherapy for localized disease is still debated. METHODS: This retrospective multicenter study included all consecutive patients who underwent curative surgical resection for localized small bowel adenocarcinoma between 1996 and 2019 from 3 French cohort studies. Prognostic and predictive factors of adjuvant chemotherapy efficacy were analyzed for disease-free survival and overall survival. The inverse probability of treatment weighting method was applied in the Cox regression model using the propensity score derived from multivariable logistic regression. RESULTS: A total of 354 patients were included: median age, 63.5 years; duodenum location, 53.5%; and tumor stage I, II, and III in 31 (8.7%), 144 (40.7%), and 179 (50.6%) patients, respectively. The adjuvant chemotherapy was administered in 0 (0%), 66 (48.5%), and 143 (80.3%) patients with stage I, II, and III, respectively (P < .0001). In the subgroup analysis by inverse probability of treatment weighting method, a statistically significant disease-free survival and overall survival benefit in favor of adjuvant chemotherapy was observed in high-risk stage II (T4 and/or <8 lymph nodes examined) and III (T4 and/or N2) but not for low-risk stage II (T3 and ≥8 lymph nodes examined) and III (T1-3/N1) tumors (Pinteraction < .05). Furthermore, tumor location in jejunum and ileum was also a statistically significant predictive factor of response to adjuvant chemotherapy in stage II and III tumors (Pinteraction < .05). CONCLUSION: In localized small bowel adenocarcinoma, adjuvant chemotherapy seems to provide a statistically significant survival benefit for high-risk stage II and III tumors and for jejunum and ileum tumor locations.

Domaines: Cancer

Aziz Zaanan, Julie Henriques, Anthony Turpin, Sylvain Manfredi, Romain Coriat, et al.. Adjuvant chemotherapy benefit according to T and N stage in small bowel adenocarcinoma: a large retrospective multicenter study. JNCI Cancer Spectrum, 2023, 7 (5), pkad064. ⟨10.1093/jncics/pkad064⟩. ⟨hal-04282951⟩