Long-term survival outcomes of duodenal adenocarcinoma: A cohort study with 15-year single-center experience.

Background: Duodenal adenocarcinoma (DA), a rare gastrointestinal malignancy, lacks clear natural history and management strategies. This study aimed to investigate the long-term outcomes of patients with DA, focusing on long-term survival and the impact of tumor characteristics, surgery, and adjuvant therapy.

Aim: To bridge this knowledge gap, we conducted a hospital-based cohort study in our 15-year experience with DA aimed at investigating the long-term outcomes of the patients with DA, along with analyzing the impact of the tumor characteristics, operations and adjuvant therapy on survival outcomes.

Methods: A retrospective analysis of 208 patients diagnosed with non-ampullary DA at a single institution between 2009 and 2023 was performed. This study used SPSS 26.0 software to make a comprehensive statistical analysis of demographic characteristics, clinical presentation, treatment modalities, and survival outcomes. The effectiveness of surgical resection and adjuvant therapy in 5-year oval survival (OS) and disease-free survival was evaluated using Kaplan-Meier survival curves, the Cox proportional hazards model, and statistical comparisons of survival distributions.

Results: The median OS time for the cohort was 39 months, with 3- and 5-year OS rates of 51.2% and 43.6%, respectively. Radical resection was performed in 82.6% of cases, and was significantly associated with an improved 5-year OS, with a rate of 57.8%. Adjuvant therapy showed a survival benefit in the specific patient subsets, particularly in tumor stage II or III tumors, with an improved OS. Adjuvant therapy (hazard ratio= 2.71, 95% confidence interval: 1.30-5.62, = 0.008), pancreatic invasion and advanced tumor stage were identified as significant predictors of OS in multivariate analyses.

Conclusion: Radical operation for DA is associated with a remarkable improvement in the 5-year OS. Importantly, postoperative adjuvant therapy can significantly prolong the OS time in patients with radical operation, especially in patients with stage III. It highlights the necessity for early diagnosis, tailored surgical approaches, and a nuanced understanding of the role of adjuvant therapy.