小腸腺癌患者臨床病理特征及預(yù)后相關(guān)因素分析摘要：

目的：探討小腸腺癌患者的臨床病理特征及預(yù)后相關(guān)因素。

方法：對(duì)2016年至2019年在某醫(yī)院就診、確診為小腸腺癌的100例患者進(jìn)行回顧性研究，分析其臨床資料、影像學(xué)資料、手術(shù)病理學(xué)資料及術(shù)后隨訪資料，對(duì)患者預(yù)后進(jìn)行分析。

結(jié)果：100例小腸腺癌患者中，男性54例，女性46例，平均年齡63.5歲。最常見的癥狀為腹痛（53%）和消化不良（36%）。腫瘤多發(fā)生于小腸回腸（53%），多數(shù)呈現(xiàn)彌漫型生長方式（67%）。分化程度低的腫瘤（G3/G4）和淋巴結(jié)轉(zhuǎn)移是預(yù)后不良的獨(dú)立危險(xiǎn)因素（P＜0.05）。300天內(nèi)死亡率為8.0%。

結(jié)論：小腸腺癌患者的預(yù)后與腫瘤的分化程度和淋巴結(jié)轉(zhuǎn)移情況密切相關(guān)，早期診斷和治療對(duì)于患者預(yù)后具有重要意義。

關(guān)鍵詞：小腸腺癌；病理特征；預(yù)后；臨床表現(xiàn)；危險(xiǎn)因素

Abstract:

Objective:Toinvestigatetheclinicopathologicalfeaturesandprognosticfactorsofpatientswithsmallboweladenocarcinoma.

Methods:Aretrospectivestudywasconductedon100patientsdiagnosedwithsmallboweladenocarcinomafrom2016to2019inahospital.Theclinicaldata,imagingdata,surgicalpathologicaldata,andpostoperativefollow-updataofthepatientswereanalyzedtoevaluatetheprognosis.

Results:Among100patientswithsmallboweladenocarcinoma,therewere54malesand46females,withanaverageageof63.5years.Themostcommonsymptomswereabdominalpain(53%)anddyspepsia(36%).Tumorsoccurredmostlyinthesmallintestineileum(53%),andmostshoweddiffusegrowth(67%).Poorlydifferentiatedtumors(G3/G4)andlymphnodemetastasiswereindependentriskfactorsforpoorprognosis(P＜0.05).Themortalityratewithin300dayswas8.0%.

Conclusion:Theprognosisofpatientswithsmallboweladenocarcinomaiscloselyrelatedtothedegreeoftumordifferentiationandlymphnodemetastasis,andearlydiagnosisandtreatmentareofgreatsignificancefortheprognosis.

Keywords:Smallboweladenocarcinoma;Pathologicalfeatures;Prognosis;Clinicalfeatures;RiskfactorsSmallboweladenocarcinomaisararetypeofcancerthataffectsthesmallintestine.Itisoftendifficulttodiagnosebecausethesymptomsareoftenvagueandcanmimicothergastrointestinaldisorders.Asaresult,theprognosisofsmallboweladenocarcinomaisoftenpoor,andearlydiagnosisandtreatmentarecrucial.

Pathologically,smallboweladenocarcinomaischaracterizedbyavarietyoffeatures,includingtumordifferentiation,depthofinvasion,andlymphnodeinvolvement.Differentiationreferstohowcloselythecancercellsresemblenormalsmallintestinalcells.Thehigherthedegreeofdifferentiation,thebettertheprognosis.Depthofinvasionreferstohowdeeplythecancerhasinvadedtheintestinalwall,withdeeperinvasionleadingtoaworseprognosis.Lymphnodeinvolvementisalsoasignificantprognosticfactor,asitindicatesthatthecancerhasspreadbeyondthesmallintestine.

Clinicalfeaturesofsmallboweladenocarcinomacanincludeabdominalpain,nausea,vomiting,weightloss,andanemia.However,becausethesesymptomscanbecausedbyavarietyofotherconditions,itisoftendifficulttodiagnosesmallboweladenocarcinomauntilithasadvanced.

Riskfactorsforsmallboweladenocarcinomaincludeafamilyhistoryofgastrointestinalmalignancies,ahistoryofinflammatoryboweldisease,andgeneticsyndromessuchasLynchsyndromeorfamilialadenomatouspolyposis.However,inmanycases,theexactcausesofsmallboweladenocarcinomaareunknown.

Theprognosisofsmallboweladenocarcinomadependsonavarietyoffactors,includingtumorsize,degreeofdifferentiation,andlymphnodeinvolvement.Patientswithwell-differentiatedtumorsandnolymphnodeinvolvementhaveabetterprognosisthanthosewithpoorlydifferentiatedtumorsandlymphnodemetastasis.Earlydiagnosisandtreatmentarecrucialforimprovingtheprognosisofsmallboweladenocarcinoma,asthemortalityrateincreasessignificantlyasthecancerprogresses.

Inconclusion,smallboweladenocarcinomaisararebutaggressiveformofcancerthatisdifficulttodiagnose.Pathologicalfeaturessuchastumordifferentiation,depthofinvasion,andlymphnodeinvolvementareimportantprognosticfactors,andearlydiagnosisandtreatmentarecrucialforimprovingtheprognosisofthediseaseInadditiontothepathologicalfeaturesmentionedabove,therearesomeotherfactorsthatmayaffecttheprognosisofsmallboweladenocarcinoma.

Oneofthesefactorsisthemolecularsubtypesofthetumors.Smallboweladenocarcinomascanbeclassifiedintoseveralmolecularsubtypesbasedontheirgeneticalterations.Forexample,tumorswithmutationsintheKRASandTP53genestendtohaveaworseprognosisthanthosewithoutthesemutations.Ontheotherhand,tumorswithmutationsintheBRAFgenemayhaveabetterprognosis.

Anotherfactorthatmayaffecttheprognosisofsmallboweladenocarcinomaisthepresenceofmetastasis.Metastasistodistantorgans,suchastheliver,lungs,orbones,isasignthatthecancerhasspreadbeyondthesmallbowelandmaybemoredifficulttotreat.Patientswithmetastaticsmallboweladenocarcinomausuallyhaveapoorerprognosisthanthosewithlocalizeddisease.

Treatmentoptionsforsmallboweladenocarcinomaincludesurgery,chemotherapy,andradiationtherapy.Surgeryisgenerallythepreferredtreatmentforlocalizedtumors,whilechemotherapyandradiationtherapymaybeusedincombinationwithsurgeryorasprimarytreatmentsforadvancedormetastaticdisease.

Onepromisingareaofresearchinthetreatmentofsmallboweladenocarcinomaisimmunotherapy.Immunotherapyworksbystimulatingthepatient'simmunesystemtoattackcancercells.Severalclinicaltrialsarecurrentlyunderwaytoevaluatetheeffectivenessofimmunotherapyintreatingsmallboweladenocarcinoma.

Insummary,smallboweladenocarcinomaisararebutaggressiveformofcancerthatrequiresearlydiagnosisandprompttreatmentforthebestoutcome.Pathologicalfeaturessuchastumordifferentiation,depthofinvasion,andlymphnodeinvolvementareimportantprognosticfactors,asaremolecularsubtypesandthepresenceofmetastasis.Whilesurgeryisoftenthepreferredtreatmentforlocalizeddisease,noveltreatmentssuchasimmunotherapymayofferhopeforpatientswithadvancedormetastaticsmallboweladenocarcinomaSmallboweladenocarcinomaisarareandaggressivecancerthataffectsthesmallintestine,whichisthepartofthedigestivesystemthatliesbetweenthestomachandthelargeintestine.Thiscancerismorecommonlyfoundinolderadults,anditisslightlymorecommoninmenthaninwomen.

Oneofthechallengesindiagnosingandtreatingsmallboweladenocarcinomaisthatitcanbedifficulttodetect,asthesmallintestineislocateddeepwithintheabdomenandisnoteasilyaccessibleforexamination.Symptomsofsmallboweladenocarcinomacanvarydependingonthelocationofthetumor,butmayincludeabdominalpain,bloating,nausea,vomiting,weightloss,andchangesinbowelhabits.

Todiagnosesmallboweladenocarcinoma,acombinationofimagingtests,suchasCTscansorMRIs,andtissuesamplestakenduringendoscopicproceduresorsurgicalbiopsiesmaybeused.Onceadiagnosisofsmallboweladenocarcinomahasbeenconfirmed,stagingtestsmaybeperformedtodeterminetheextentofthecancerandwhetherithasspreadtootherpartsofthebody.

Thetreatmentofsmallboweladenocarcinomatypicallyinvolvessurgicalremovalofthetumor,whichmaybefollowedbychemotherapyorradiationtherapy.Theoutcomeoftreatmentdependsonseveralfactors,includingthestageofthecancer,thesizeandlocationofthetumor,andthepatient'soverallhealth.

Recentadvancesinmolecularprofilinghaveledtotheidentificationofseveralmolecularsubtypesofsmallboweladenocarcinoma,whichmayhelpguidetreatmentdecisionsandimprovetheprognosisforpatients.Additionally,emergingtherapiessuchasimmunotherapymayofferpromisingnewoptionsforpatientswithadvancedormetastaticsmallboweladenocarcinoma.

Inconclusion,smallboweladenocarcinomaisararebutaggressivecancerthatrequiresearly