Abstract: 【Abstract】Objective:To summarize the clinical characteristics and investigate the prognostic factors of primary duodenal carcinoma.
Methods:The clinical data of 122 patients with primary duodenal carcinoma who were admitted to the Shengjing Hospital Affiliated to China Medical University from November 2007 to May 2013 were retrospectively analyzed. All the patients received different operations according to the characteristics of tumors. Primary duodenal carcinomas of patients were confirmed by the postoperative pathological diagnosis. All the patients were followed up by outpatient examination, telephone interview and correspondence till November 30, 2014. The treatment process, results of imaging examination and laboratory examination and postoperative survival were recorded. The clinical features, diagnostic criteria, therapeutic regimens and prognostic factors were analyzed. The survival rate and survival curve were analyzed and drawn by the KaplanMeier method. The univariate analysis was done using the Logrank test, and multivariate analysis was done using the COX regression model.
Results Among the 122 patients with primary duodenal carcinoma, jaundice as the first symptom was detected in 57 patients, abdominal pain and upper abdomen discomfort in 37 patients, gastrointestinal obstruction in 14 patients, anorexia and reduction of body weight in 4 patients,  gastrointestinal hemorrhage in 3 patients, diarrhea in 3 patients, pyrexia in 3 patients and abdominal mass in 1 patient. The positive rates of CT examinations, endoscopic examinations, magnetic resonanced cholangiopancreatography (MRCP),  Bultrasound examinations and upper gastrointestinal contrast examinations were 69.67%(85/122), 85.56%(77/90), 79.76%(67/84), 12.73%(7/55) and 75.00%(36/48), respectively. Among the 122 patients, anemia was detected in 48 patients, positive fecal occult blood test in 94 patients, increasing level of CA19-9 in 71 patients, increasing level of CEA in 22 patients and increasing level of AFP in 9 patients. The tumors located at the descending part of duodenum, duodenal bulb and horizontal part of duodenum were detected in patients of 86.07%(105/122), 7.37%(9/122) and 6.56%(8/122), respectively. The mean diameter of tumors was 2.3 cm (range, 1.0-15.0cm). All the 122 patients received operation. Pancreaticoduodenectomy was performed in 100 patients, including combined with jejunostomy in 17 patients, pyloruspreserving pancreatoduodenectomy in 7 patients, segmental resection of duodenum and gastrojejunostomy in 5 patients,  local resection of duodenal papilla in 6 patients and palliative gastrojejunostomy in 11 patients. Nineteen patients with complications were cured by symptomatic treatment. Of the 122 patients, adenocarcinoma, carcinoid tumor, lymphoma, small cell carcinoma,  intraepithelial neoplasm combined with differentiated rhabdomyoma and with undifferentiated rhabdomyoma were detected in 116, 2, 1, 1, 1 and 1 patients, respectively.  The Ⅰ, Ⅱ, Ⅲ and Ⅳ stage of tumors were detected in 10, 4, 74 and 34 patients. There were 100 patients without lymph node metastasis, 13 patients with 0<metastatic lymph node ratio (MLR)≤0.2, 4 patients with 0.2<MLR≤0.4 and 5 patients with MLR>0.4. Onehundred and twelve of 122 patients were followed up for 1-70 months with a median followup time of 20 months. The postoperative survival time, a median of survival time, postoperative 3 and 5year survival rates were 1-70 months, 18 months, 36.6% and 13.5%, respectively. The results of univariate analysis showed that the lymph node metastasis, differentiated grade of tumor, MLR and with invasion of pancreas were risk factors affecting the prognosis of patients (χ²= 8.465, 57.355,  16.232, 20.112, P<0.05). The multivariate analysis showed that the lowdifferentiation of tumor, invasion of pancreas, lymph node metastasis and MLR>0.4 were independent risk factors affecting the prognosis of patients (RR=3.330, 3.718, 2.623, 95% confidence interval: 1.861-5.956, 1.29²-10.696, 1.624-4.236, P<0.05).
Conclusions: Most of the primary duodenal carcinomas are located at the descending part of duodenum without specific clinical symptoms in the early stage. The joint usage of assistant examinations can improve the diagnostic rate of primary duodenal carcinoma, and surgery is mainly therapeutic method. The lowdifferentiation of tumor, MLR>0.4 and invasion of pancreas are independent risk factors affecting the prognosis of patients.