Prognostic factors for primary duodenal adenocarcinoma

Background: The aim of this study was to review the clinical features of primary duodenal adenocarcinoma (PDA) patients and to identify factors that influence survival. The natural history of PDA and the factors that affect patient outcome remain poorly defined. Methods: The authors reviewed the medical records of 53 patients treated for PDA from January 1995 to May 2007. Results: Altogether, 28 of the 53 patients (resectability 52.8%) underwent curative resection and 25 (47.2%) surgical palliation (bypass surgery or biopsy). Overall, the 3- and 5-year survival rates were 34.4% and 28.6%, respectively. Survival was significantly higher for patients who underwent curative resection (median survival 39 months; 3- and 5-year survivals 52.9% and 44.1%, respectively) than for those who underwent palliative surgery (median survival 8 months; 3-year survival 0%) (p < 0.001). T stage (p = 0.032) and nodal metastasis (p = 0.002) had significant negative effects on the survival of patients who underwent curative resection according to univariate analysis. However, multivariate analysis revealed that only nodal metastasis (p = 0.015) was significantly associated with survival. Conclusions: The resectability of PDA was associated with increased survival, and metastasis to lymph nodes was found to be associated with reduced survival of patients with PDA. Findings indicate that an aggressive surgical approach should be pursued.