Prognostic Role of Mismatch Repair Status, Histotype and High-Risk Pathologic Features in Stage II Small Bowel Adenocarcinomas

Alessandro Vanoli, Federica Grillo, Camilla Guerini, Giuseppe Neri, Giovanni Arpa, Catherine Klersy, Gabriella Nesi, Paolo Giuffrida, Gianluca Sampietro, Sandro Ardizzone, Paolo Fociani, Roberto Fiocca, Giovanni Latella, Fausto Sessa, Antonietta D'Errico, Deborah Malvi, Claudia Mescoli, Massimo Rugge, Stefano Ferrero, Gilberto PoggioliFernando Rizzello, Maria C. Macciomei, Donatella Santini, Umberto Volta, Roberto De Giorgio, Giacomo Caio, Antonio Calabro, Carolina Ciacci, Maria D'Armiento, Aroldo Rizzo, Gaspare Solina, Michele Martino, Francesco Tonelli, Vincenzo Villanacci, Renato Cannizzaro, Vincenzo Canzonieri, Ada Maria Florena, Livia Biancone, Giovanni Monteleone, Roberto Caronna, Antonio Ciardi, Luca Elli, Flavio Caprioli, Maurizio Vecchi, Renata D'Inca, Fabiana Zingone, Anna D'Odorico, Marco Vincenzo Lenti, Barbara Oreggia, Luca Reggiani Bonetti, Antonino Giulio Giannone, Augusto Orlandi, Valeria Barresi, Rachele Ciccocioppo, Giuseppe Amodeo, Elena Biletta, Ombretta Luinetti, Paolo Pedrazzoli, Andrea Pietrabissa, Gino Roberto Corazza, Enrico Solcia, Marco Paulli, Antonio Di Sabatino

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Background. Small bowel adenocarcinoma is a relatively rare cancer, often diagnosed in an advanced stage. In localized and resectable disease, surgery alone or in combination with adjuvant chemotherapy is the mainstay of treatment. In the recently published National Comprehensive Cancer Network Clinical Practice guidelines, criteria for selecting patients with stage II small bowel adenocarcinoma to receive adjuvant chemotherapy are provided, and they are mainly extrapolated from studies on colorectal cancer. Patients and Methods. In the present study, we aimed to verify whether mismatch repair deficiency phenotype, high-risk pathologic features (including T4, positive resection margins and a low number of lymph nodes harvested), as well as tumor histologic subtype, were associated with cancer-specific survival in 66 stage II non-ampullary small bowel adenocarcinoma patients, collected through the Small Bowel Cancer Italian Consortium. A central histopathology review was performed. Mismatch repair deficiency was tested by immunohistochemistry for MLH1, MSH2, MSH6 and PMS2, and confirmed by polymerase chain reaction for microsatellite instability. Results. We identified mismatch repair deficiency, glandular/medullary histologic subtype, and celiac disease as significant predictors of favorable cancer-specific survival using univariable analysis with retained significance in bivariable models adjusted for pT stage. Among the high-risk features, only T4 showed a significant association with an increased risk of death; however, its prognostic value was not independent of mismatch repair status. Conclusions. Mismatch repair protein expression, histologic subtype, association with celiac disease, and, in the mismatch repair proficient subset only, T stage, may help identify patients who may benefit from adjuvant chemotherapy. [GRAPHICS] .
Original languageEnglish
JournalAnnals of Surgical Oncology
Publication statusPublished - 2020


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