Adenocarcinoma of the ampulla of Vater: predictors of survival and recurrence after curative radical resection

Kim, Kang Jae; Choi, Dong Wook; Kim, Woo Seok; Kim, Min Jung; Song, Sun Choon; Heo, Jin Seok; Choi, Seong Ho

doi:10.14701/kjhbps.2011.15.3.171

Cited by 11 publications

(8 citation statements)

References 29 publications

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“…The prognostic factors associated with shorter RFS in the present study were almost similar with those of the previous series 1–5 . The point of difference was that histological subtype was not an independent factor associated with poor prognosis in the present study.…”

Section: Discussionsupporting

confidence: 87%

“…Multiplicity of prognosis in CAV patients may be due to the heterogeneity of tumor biology, morphological diversity, and genetic alteration in CAV. To date, various clinicopathological factors associated with poor prognosis in patients with CAV have been determined, including tumor marker, nodal involvement, pathological T stage (pT), lymphovascular invasion, perineural invasion, histopathological subtypes, and adjuvant chemotherapy (AC) 1–5 . However, definitive data are still lacking since most studies were conducted in a small number of patients at a single institution.…”

Section: Introductionmentioning

confidence: 99%

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Identification of patients at high risk for recurrence in carcinoma of the ampulla of Vater: Analysis in 460 patients

Narita,

Hatano,

Kitamura

et al. 2023

Annals of Gastroent Surgery

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AimCarcinoma of the ampulla of Vater (CAV) shows a favorable prognosis compared to that with the other periampullary tumors, while some cases have a poor prognosis. The aims of the present study are to clarify the clinicopathological factors associated with poor recurrence‐free survival (RFS) in patients with CAV after curative resection and to validate the usefulness of adjuvant chemotherapy (AC).PatientsThe study design is a multicenter retrospective cohort study. Patients with CAV who underwent pancreaticoduodenectomy between January 2008 and December 2020 at 26 hospitals were analyzed. The 30 clinicopathological factors were evaluated. A propensity score matching (PSM) was used to compare between patients with and without AC.ResultsFinally, 460 patients were analyzed. Median duration of follow‐up was 47.2 months. Twenty‐one prognostic factors associated with poor RFS were identified by univariate analysis. In multivariate analysis, aged ≥71, tumor diameter ≥12 mm, pT2 or higher stage (pT≥2), portal vein invasion (PV+), venous invasion(V+), and node positive disease (pN+) were independent prognostic factors for poor RFS. Out of 80 patients who received AC, 63 patients were assigned to analysis for PSM. The results showed no beneficial effect of AC on RFS. The preoperative factors potentially predicting pT≥2, V+, and/or N+ were at least one of following; (1) CA19‐9 > 37 IU/mL, (2) ulcerative or mixed type appearance, (3) except for well‐differentiated tumor, or (4) except for intestinal subtype of histology.ConclusionsAged ≥71, tumor diameter ≥12 mm, pT≥2, PV+, V+, and pN+ were independent prognostic factors for poor RFS in patients with CAV. An additional therapeutic strategy may be desirable in CAV patients at high risk for recurrence.

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Section: Discussionsupporting

confidence: 87%

Section: Introductionmentioning

confidence: 99%

Identification of patients at high risk for recurrence in carcinoma of the ampulla of Vater: Analysis in 460 patients

Narita,

Hatano,

Kitamura

et al. 2023

Annals of Gastroent Surgery

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“…This is because more than 60% of patients who underwent radical resection recurred within 12 months, and the 3-year survival rate of this patient group was 19.5%, and the 5-year survival rate was 10.5%, which was significantly lower than that of the late recurrence group. In previous studies of AoV cancer recurrences, T stage, local lymph node metastasis, positive LNR, LVI, PNI, and a preoperatively increased CEA have been reported as recurrence factors [ 2 6 15 22 23 ]. In our present study, the factors affecting recurrence included, positive LNR (LNR ≥ 0.2), LNI, and advanced T stage showed significant results which was consistent with previous findings.…”

Section: Discussionmentioning

confidence: 99%

“…However, the incidence of AoV cancer is very low (about 0.2% of all gastrointestinal cancers) and most prior studies have attempted to predict the prognosis of these cases by analyzing the clinicopathological characteristics of fewer than 100 patients. Indeed, there have been few studies on the factors affecting AoV recurrence [ 1 2 14 15 16 17 18 19 20 21 ]. The purpose of our present study was to identify the factors affecting the recurrence rate after curative surgery for AoV cancer, particularly in relation to early recurrence, and to thereby provide a basis for establishing novel adjuvant therapy strategies.…”

Section: Introductionmentioning

confidence: 99%

Predictors of early recurrence following a curative resection in patients with a carcinoma of the ampulla of Vater

et al. 2020

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Purpose Ampulla of Vater (AoV) carcinoma has a relatively good prognosis. The 5-year recurrence rate for AoV is still around 40%–50% however, and most recurrences occur in the early period. The aim of this study was to identify predictors of an early recurrence in AoV patients following a curative resection. Methods The clinicopathological data for 501 consecutive patients that underwent a resection for AoV in our institute between January 2000 and December 2015 were retrospectively reviewed. The characteristics of any recurrences and early recurrence patients were analyzed accordingly. Early recurrence was defined as occurring within one year of resection. Results There were 170 diagnosed recurrences in our study population, 57.1% of whom were men, with a mean age of 60.1 years (range, 30–94 years). Almost all of the study patients underwent a pancreaticoduodenectomy, and 9% underwent minimally invasive surgery. Of the 170 recurrent cases, 107 were diagnosed with an early recurrence and had 1-, 3-, and 5-year overall survival rates of 77.7%, 18.4%, 10.5%, respectively. The factors that significantly influenced early recurrences, determined by multivariate analysis, lymphovascular invasion (LVI), lymph node ratio (LNR), and poor differentiation were found to be independent determinants of a recurrence within 1 year. Conclusion An early recurrence in AoV patients is ultimately lethal even though this cancer has a good prognosis. LVI, LNR, and poor differentiation are powerful predictors of an early recurrence in AoV. Hence, intensive surveillance and new therapeutic strategies should be considered for AoV patients with these predictors following a curative resection.

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“…Among 1469 pancreatoduodenectomy specimens from the archives of the authors' pathology departments, 249 consecutive, stringently defined cases of invasive ampullary carcinoma (with a frequency of 17%, similar to that of most major studies) [24][25][26][27] were culled.…”

Section: Case Selectionmentioning

confidence: 99%

Ampullary carcinoma is often of mixed or hybrid histologic type: an analysis of reproducibility and clinical relevance of classification as pancreatobiliary versus intestinal in 232 cases

et al. 2016

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Histologic classification of ampullary carcinomas as intestinal versus pancreatobiliary is rapidly becoming a part of management algorithms, with immunohistochemical classification schemes also being devised using this classification scheme as their basis. However, data on the reproducibility and prognostic relevance of this classification system are limited. In this study, five observers independently evaluated 232 resected ampullary carcinomas with invasive component >3 mm. Overall interobserver agreement was 'fair' (κ 0.39; P<0.001) with complete agreement in 23%. Using agreement by 3/5 observers as 'consensus' 40% of cases were classified as 'mixed' pancreatobiliary and intestinal. When observers were asked to provide a final diagnosis based on the predominant pattern in cases initially classified as mixed, there was 'moderate' agreement (κ 0.44; P<0.0001) with 5/5 agreeing in 35%. Cases classified as pancreatobiliary by consensus (including those with pure-pancreatobiliary or mixed-predominantly pancreatobiliary features) had shorter overall (median 41 months) and 5-year survival (38%) than those classified as pure-intestinal/mixed-predominantly intestinal (80 months and 57%, respectively; P=0.026); however, on multivariate analysis this was not independent of established prognostic parameters. Interestingly, when compared with 476 cases of pancreatic ductal adenocarcinomas, the pancreatobiliary-type ampullary carcinomas had better survival (16 versus 41 months, P<0.001), even when matched by size and node status. In conclusion, presumably because of the various cell types comprising the region, ampullary carcinomas frequently show mixed phenotypes and intratumoral heterogeneity, which should be considered when devising management protocols. Caution is especially warranted when applying this histologic classification to biopsies and tissue microarrays. While ampullary carcinomas with more pancreatobiliary morphology have a worse prognosis than intestinal ones this does not appear to be an independent prognostic factor. However, pancreatobiliary-type ampullary carcinomas have a much better prognosis than their pancreatic counterparts.

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Adenocarcinoma of the ampulla of Vater: predictors of survival and recurrence after curative radical resection

Cited by 11 publications

References 29 publications

Identification of patients at high risk for recurrence in carcinoma of the ampulla of Vater: Analysis in 460 patients

Identification of patients at high risk for recurrence in carcinoma of the ampulla of Vater: Analysis in 460 patients

Predictors of early recurrence following a curative resection in patients with a carcinoma of the ampulla of Vater

Ampullary carcinoma is often of mixed or hybrid histologic type: an analysis of reproducibility and clinical relevance of classification as pancreatobiliary versus intestinal in 232 cases

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