Clinical Characteristics Of Patients With Small Intestinal Malignant Tumor Of Small Intestine

Research background:The small intestine is the longest human digestive organs,including three parts,duodenum,jejunum,ileum,is the main place to human digestion,absorption and secretion.Due to the fast passage of food through the small intestine,the secretion of a variety of enzymes and a large amount of Ig A from the small intestine,and the rich lymphoid tissue,the rapid renewal of the mucosal epithelial cells,so the small intestinal malignancies are relatively rare,accounting for only 1% to 3% of all gastrointestinal malignancies.Foreign reports show that the incidence of small intestinal malignancy is increasing year by year.In 1975,the incidence of small intestinal malignancy was 1.1 per 100,000 people in the United States,but it rose to 2.4 per 100,000 in 2018,an increase of 118%.At present,the lack of small intestinal malignant tumor mass clinical investigation and study,some single center survey report shows that the incidence of small intestinal malignant tumor in our country is also on the rise.The early clinical symptoms and signs of small intestinal malignant tumor are not prominent,and some non-specific gastrointestinal symptoms only appear when the tumor is large,and the small intestine has a special anatomical structure,which cannot be determined by routine examination,so early diagnosis is difficult.In recent years,with the development of capsule endoscopy and colonoscopy,the detection rate of intestinal malignancy has been greatly improved.However,there are still some cases such as the lack of in-depth understanding and timely diagnosis and treatment of small intestinal malignant tumor,and misdiagnosis and missed diagnosis occur from time to time.This study retrospectively analyzed between January 2013 and December 2018 in The First Affiliated hospital of Dalian Medical Uiversity hospital diagnosis of small intestinal malignant tumor patients' clinical data,through the comparative analysis of different types of small intestinal malignant tumor patients with general situation,clinical symptoms and signs,tumor site,pathological type and diagnosis methods,the differences between the treatment and so on,improve the understanding of small intestinal malignant tumor,is helpful to the diagnosis and treatment in patients with guidance.Object:By analyzing the clinical data of patients with small intestinal malignant tumor,the clinical characteristics were summarized to improve the understanding of small intestinal malignant tumor and provide reference for clinical diagnosis,treatment and prognosis.Methods:Patients diagnosed as small intestinal malignancy in The First Affiliated hospital of Dalian Medical Uiversity from January 2013 to December 2018 were selected as the study subjects.All patients were confirmed by endoscopic pathological biopsy or surgical resection of lesions.According to the presence or absence of primary lesions,the patients were divided into primary malignant tumor group and secondary malignant tumor group.Small intestine primary malignant tumors according to the pathological type,divided into Small bowel adenocarcinoma(SBA)group,Small intestinal stromal tumors(SISTs)group,Small intestinal neuroendocrine neoplasms(SI-NENs)group,Primary small intestinal lymphoma(PSIL)group,small intestinal melanoma(SIM)group and small intestinal leiomyosarcoma(SIL)group.The clinicopathological data of all the patients were collected and statistically analyzed to compare the differences between the two groups in gender,age,symptoms,signs,laboratory and imaging examination results,pathological results,tumor sites,diagnostic methods and treatment plans.Results:1.Clinical features of malignant tumor of small intestine(1)general situation: there were 152 patients with small intestinal malignant tumor,including 86 males and 66 females(male: female =1.3:1),aged from 32 to 91 years old,with an average age of(61.6±11.3)years old.(2)clinical manifestations: abdominal pain or abdominal discomfort was the most common,followed by gastrointestinal bleeding,intestinal obstruction,nausea,vomiting,diarrhea and other gastrointestinal symptoms,some of them may appear fever,fatigue,weight loss and other systemic symptoms,a few patients without symptoms,physical examination found that signs of jaundice is more common,followed by abdominal mass,peritonitis,anemia.(3)laboratory examination: 57.9%(88/152)of the patients with malignant tumor of the small intestine had decreased Hb,19.9%(27/136)of the patients had increased CEA,and 39.7%(54/136)of the patients had increased ca19-9,indicating that 50.0%(16/32)of the patients had positive occult blood.(4)auxiliary examination: the detection rates of small intestine X-ray barium contrast and abdominal color ultrasound were 80.0%(12/15)and 67.9%(19/28),respectively.Abdominal CT and MRI detection rates were 88.0%(88/100)and 95.8%(46/48),respectively,pet-ct detection rates were 100.0%(8/8),and endoscopic detection rates were 96.3%(79/82).(5)diseased region:most lesions were found in the duodenum,accounting for 62.5%(95/152),followed by jejunum(17.8%(27/152),ileum(13.8%(21/152),and ileum unknown(5.9%(9/152).(6)pathological types: adenocarcinoma accounted for 66.4%(101/152),stromal tumor for 23.0%(35/152),lymphoma for 3.3%(5/152),neuroendocrine tumor for2.6%(4/152),squamous cell carcinoma for 2.6%(4/152),leiomyosarcoma for 0.7%(1/152),and melanoma for 1.3%(2/152).(7)treatment regimen: simple surgery was the main treatment regimen for small intestinal malignancies,accounting for 69.7%(106/152).Some patients received chemotherapy alone(2.6%(4/152),surgery combined with chemotherapy(9.2%(14/152),interventional therapy(7.9%(12/152),and symptomatic support therapy(10.5%(16/152).2.Comparison of clinical characteristics between the small intestine secondary malignant tumor group and the small intestine primary malignant tumor group(1)there were 132 cases of primary malignant tumors of the small intestine,accounting for 86.8%,male: female = 1.1:1,with an average age of 61.1±11.2 years;20 cases of secondary malignant tumors of the small intestine,accounting for 13.2%,male: female =1.5:1,with an average age of 65.5±11.1 years.(2)there was no statistically significant difference in the proportion of clinical manifestations between the two groups of patients with primary malignant tumor and secondary malignant tumor of the small intestine(P > 0.05).The decrease of Hb in the small intestine secondary malignant tumor group was 100.0%(20/20)higher than that in the small intestine primary malignant tumor group(51.5%(68/132),and the difference was statistically significant(P<0.05).(3)duodenal lesions were the most common in the primary malignant tumor group,accounting for 66.7%(88/132),which was higher than that in the secondary malignant tumor group 35.0%(7/20).The difference was statistically significant(P<0.05).(4)there was no statistically significant difference in the detection rate of various auxiliary examination methods between the two groups(P > 0.05).(5)the two groups of small intestinal primary and secondary malignant tumors were mainly treated by simple surgery,and there was no statistically significant difference in the implementation ratio of each treatment plan(P > 0.05).3.Comparison of clinical characteristics of patients with different pathological types in primary malignant tumor of small intestine(1)there were 86 cases in SBA group,male: female =1.15:1,with an average age of62.5±10.8 years.There were 35 cases in the SISTs group,male: female =1.7:1,with an average age of 58.3±12.2 years.5 patients in the PSIL group had an average age of60.0±9.3 years.SI-NENs group included 4 patients with an average age of 57.3±12.1years.One case of SIM and one SIL was female,aged 51 and 61 years respectively.(2)jaundice and fever in SBA group accounted for 40.7%(35/86)and 12.8%(11/86),which were higher than those in SISTs group.Gastrointestinal bleeding in SBA group accounted for 7.0%(6/86),peritonitis in 1.2%(1/86)and abdominal mass in 2.3%(2/86)were significantly lower than those in SISTs group,with statistically significant differences(P<0.05).(3)most of the lesions in the SBA group were located in the duodenum,accounting for 88.4%(76/86),while those in the SISTs group were mainly located in jejunum37.1%(13/35)and ileum 28.6%(10/35).The difference between the groups was statistically significant(P<0.05).(4)the proportion of CEA and CA19-9 increased in the SBA group was 20.5%(16/78)and 61.0%(47/77),which was significantly higher than that in the SISTs group,and the difference was statistically significant(P<0.05).The detection rate of CT in the SISTs group was 100.0%(26/26)higher than that in the SBA group,and the difference was statistically significant(P<0.05).There was no statistically significant difference in the detection rate of residual auxiliary examination methods(P > 0.05).(5)the proportion of surgical patients in the SISTs group was 100.0%(35/35)higher than that in the SBA group,and the difference was statistically significant(P<0.05).Conclusion:1.Primary and secondary malignant tumors of the small intestine are most common in middle and old age,and are more common in males.2.The clinical manifestations of small intestinal malignancy are mainly non-specific gastrointestinal symptoms,and some types may have jaundice,gastrointestinal bleeding and abdominal mass.3.The malignant tumors of the small intestine are mainly located in the duodenum,and the prone sites of different pathological types are different.4.Positive fecal occult blood,anemia patients except stomach,colon diseases,to pay attention to the possibility of small bowel cancer.5.CT and MRI examination have a certain value in differentiating different pathological types of small intestinal malignancies.PET-CT examination can accurately detect small intestinal malignancies and identify distant metastatic lesions,which is worthy of popularization and application.6.Capsule endoscopy and enteroscopy have important diagnostic value.Endoscopic ultrasound is suitable for the diagnosis of duodenal submucosal tumors.7.The primary malignant tumor of small intestine should be treated with radical operation,chemotherapy or targeted therapy to improve the curative effect.Interventional stent therapy is mainly used to alleviate obstructive jaundice.The secondary malignant tumor of small intestine should be treated with palliative operation,symptomatic treatment and nutritional support.