Caractérisation des patients ayant des métastases opérées d’adénocarcinome de l’intestin grêle

Introduction: Small bowel adenocarcinoma (SBA) is an uncommon tumor and the therapeutic management is not well established. The curative treatment for resectable tumor and its metastases is carcinological surgery. Unfortunately, the most common treatment performed for metastatic tumor is palliative chemotherapy (CT). Results: This retrospective study assessed clinical, paraclinical, overall survival (OS) and progression-free survival (PFS) in 34 patients with resected metastasis mainly coming from NADEGE’s cohort. Patients had synchronous metastases (25) or metachronous metastases (9). Ileal primitive localization was twice as common compared with patients in NADEGE’s cohort. Adjuvant CT was given to 29/34 patients after metastatic surgery and among them 25 had oxaliplatin. The OS for patients treated with surgery +/- CT was 25.1 months. The PFS was 13.6 months and increased to 21.2 months for patients with healthy resection margins. In univariate analyses, factors associated with a decrease of OS were adjuvant CT without oxaliplatin (p=0.034), a poorly differentiated histology (p=0.0037) and an invaded resection margin (p=0.014). Conclusion: AIG’s with resected metastases provides an increase of OS compared with those reported in the literature without surgery. Nevertheless, this OS remains lesser than the OS for colorectal cancer with resected metastases. Adjuvant CT with oxaliplatin and carcinological surgery are major prognostic factors.Introduction : L’adénocarcinome de l’intestin grêle (AIG) est une tumeur rare et sa prise en charge n’est pas bien codifiée. Le seul traitement curatif de l’AIG et de ses métastases est la chirurgie carcinologique. Malheureusement, le traitement le plus fréquemment réalisé au stade métastatique reste une chimiothérapie (CT) palliative. Résultats : Ce travail rétrospectif a étudié les caractéristiques cliniques, paracliniques, la survie globale (SG) et la survie sans progression (SSP) chez 34 patients, majoritairement issus de la cohorte NADEGE, présentant un AIG avec métastases réséquées. Les patients avaient des métastases synchrones (25) ou métachrones (9). La localisation iléale du primitif était deux fois plus fréquente que chez l’ensemble des patients de la cohorte NADEGE. Une CT adjuvante (après chirurgie des métastases) a été réalisée chez 29/34 patients et parmi eux 25 avaient de l’oxaliplatine. La SG des patients traités par chirurgie +/- CT était de 25,1 mois. La SSP était de 13,6 mois et augmentait à 21,2 mois chez les patients présentant des marges de résection saines. En analyse univariée les facteurs associés à une mauvaise SG étaient l’absence de CT adjuvante par oxaliplatine (p=0,034), une histologie peu différenciée (p=0,0037) et des marges de résection envahies (p=0,014). Conclusion : La résection des métastases des AIG permet d’obtenir une SG supérieure à celle observée dans la littérature en l’absence de chirurgie mais apparait moindre que celle observée dans le cancer colorectal. Une chimiothérapie adjuvante par oxaliplatine et une chirurgie carcinologique sont des facteurs pronostiques majeurs

Resection of small bowel adenocarcinoma metastases: Results of the ARCAD-NADEGE cohort study

International audienceINTRODUCTION:Data are lacking with regard to curative resection of metastasis from small bowel adenocarcinoma (SBA). This study evaluated outcomes and prognostic factors in patients with curatively resected metastatic SBA.METHODS:A series of 34 patients undergoing resection of metastatic SBA from January 2009 to November 2014 at French centers were included into this cohort study. The primary endpoint was overall survival (OS). Secondary endpoints were recurrence-free survival (RFS) and prognostic factors. Univariate analyses were performed to determine prognostic risk factors.RESULTS:The sites of SBA metastases were peritoneal (29.4%), liver (26.5%), lymph nodes (11.8%), lung (2.9%), multiple (14.7%), and other (14.7%). Thirty (88.2%) patients received adjuvant or perioperative chemotherapy, mainly was oxaliplatin-based (76.5%). The median OS was 28.6 months and RFS was 18.7 months. Fourteen (41.2%) patients survived for more than 36 months. In univariate analysis, poor differentiation (P = 0.006), invaded margins (P = 0.003), and lymphatic invasion in the primary tumor (P = 0.039) were associated with decreased OS.CONCLUSION:Overall survival of patients after resection of metastatic SBA remains poor, but long-term survivors are observed. Resection of metastatic SBA should be consider if patients are expected to be operated on with curative intent and have moderately or well-differentiated tumors