Prognostic factors and benefits of adjuvant therapy for ampullary cancer following pancreatoduodenectomy: A systematic review and meta-analysis

Zhou, Yanming; Liao, Shan; Wei, You-Zhu; Wang, Shijie

doi:10.1016/j.asjsur.2020.03.007

Cited by 8 publications

(7 citation statements)

References 66 publications

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“…Various factors have previously been described to be associated with AAC patient outcomes. In a meta-analysis, Zhou and colleagues identified age (> 65 years old), tumour size (> 20 mm), poor differentiation, PB-type, pT3-T4 stage diseases, lymph node metastasis, perineural invasion, lymphovascular invasion, pancreatic invasion, and positive surgical margins as independent factors associated with lower survival[ 32 ]. However, Koprowski and colleagues claimed that histotypes were not correlated with OS and concluded that disease stage was the primary determinant of patient outcomes[ 33 ].…”

Section: Discussionmentioning

confidence: 99%

Survival after curative pancreaticoduodenectomy for ampullary adenocarcinoma in a South American population: A retrospective cohort study

Fernandez-Placencia¹,

Montenegro²,

Guerrero³

et al. 2022

WJGS

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BACKGROUND Ampullary adenocarcinoma (AAC) is a rare neoplasm that accounts for only 0.2% of all gastrointestinal cancers. Its incidence rate is lower than 6 cases per million people. Different prognostic factors have been described for AAC and are associated with a wide range of survival rates. However, these studies have been exclusively conducted in patients originating from Asian, European, and North American countries. AIM To evaluate the histopathologic predictors of overall survival (OS) in South American patients with AAC treated with curative pancreaticoduodenectomy (PD). METHODS We analyzed retrospective data from 83 AAC patients who underwent curative (R0) PD at the National Cancer Institute of Peru between January 2010 and October 2020 to identify histopathologic predictors of OS. RESULTS Sixty-nine percent of patients had developed intestinal-type AAC (69%), 23% had pancreatobiliary-type AAC, and 8% had other subtypes. Forty-one percent of patients were classified as Stage I, according to the AJCC 8 th Edition. Recurrence occurred primarily in the liver ( n = 8), peritoneum ( n = 4), and lung ( n = 4). Statistical analyses indicated that T3 tumour stage [hazard ratio (HR) of 6.4, 95% confidence interval (CI) of 2.5-16.3, P < 0.001], lymph node metastasis (HR: 4.5, 95%CI: 1.8-11.3, P = 0.001), and pancreatobiliary type (HR: 2.7, 95%CI: 1.2-6.2, P = 0.025) were independent predictors of OS. CONCLUSION Extended tumour stage (T3), pancreatobiliary type, and positive lymph node metastasis represent independent predictors of a lower OS rate in South American AAC patients who underwent curative PD.

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Section: Discussionmentioning

confidence: 99%

Survival after curative pancreaticoduodenectomy for ampullary adenocarcinoma in a South American population: A retrospective cohort study

Fernandez-Placencia¹,

Montenegro²,

Guerrero³

et al. 2022

WJGS

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“…3,23 Each ampullary cancer subtype seems to resemble its periampullary counterpart in terms of biologic behavior and prognosis, with the pancreatobiliary subtype demonstrating higher lymph node involvement and worse survival than the intestinal subtype. 16,23,27,[29][30][31][35][36][37] In a retrospective study of 95 ampullary cancers and 206 matching periampullary cancers, the OS of pancreatobiliary subtype was comparable to that of pancreatic cancer (25 vs 14 months; P5. 123), but worse than that for intestinal subtype (25 vs 98 months; P,.001).…”

Section: Overviewmentioning

confidence: 93%

“…Patients who are at high risk, such as those with higher T-and N-stage disease, seemed to benefit more from both adjuvant chemotherapy and adjuvant chemoradiation. 136 Two large metaanalyses, one that included 71 studies and 8,280 patients, 16 and the other that included 10 studies and 3,361 patients, 137 together with many smaller retrospective studies, agree on the benefit of adjuvant therapy, whether chemotherapy, RT, or chemoradiation for resected ampullary cancers. [108][109][110]125,[138][139][140] Some studies have also documented the usefulness of adjuvant therapy specifically for patients with lymph node involvement.…”

Section: Adjuvant Therapymentioning

confidence: 99%

“…3 The 5-year overall survival (OS) for ampullary cancer is between 35% and 50%; however, prognosis can vary greatly based on a variety of factors such as patient age, TNM classification, differentiation grade, and treatment modality received. [4][5][6][7][8][9][10][11][12][13][14][15][16] For example, the 5-year OS for AJCC 7th Edition stage I, stage II, and stage III 1 IV ampullary cancers is 64%, 27%, and 17%, respectively. 11 Similar to in other malignancies, distant metastatic disease bodes a particularly poor prognosis for ampullary cancer.…”

Section: Overviewmentioning

confidence: 99%

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Ampullary Adenocarcinoma, Version 1.2023, NCCN Clinical Practice Guidelines in Oncology

Chiorean

Chiaro

Tempero

et al. 2023

Journal of the National Comprehensive Cancer Network

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Ampullary cancers refer to tumors originating from the ampulla of Vater (the ampulla, the intraduodenal portion of the bile duct, and the intraduodenal portion of the pancreatic duct), while periampullary cancers may arise from locations encompassing the head of the pancreas, distal bile duct, duodenum, or ampulla of Vater. Ampullary cancers are rare gastrointestinal malignancies, and prognosis varies greatly based on factors such as patient age, TNM classification, differentiation grade, and treatment modality received. Systemic therapy is used in all stages of ampullary cancer, including neoadjuvant therapy, adjuvant therapy, and first-line or subsequent-line therapy for locally advanced, metastatic, and recurrent disease. Radiation therapy may be used in localized ampullary cancer, sometimes in combination with chemotherapy, but there is no high-level evidence to support its utility. Select tumors may be treated surgically. This article describes NCCN recommendations regarding management of ampullary adenocarcinoma.

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“…Histological classification was created subdividing adenocarcinomas into intestinal type and pancreaticobiliary (PB) type (11). This classification continues to be revised, while the PB type has consistently shown poorer outcomes (12).…”

Section: Introductionmentioning

confidence: 99%

From endoscopic resection to pancreatoduodenectomy: a narrative review of treatment modalities for the tumors of the ampulla of Vater

Taliente¹,

Bianco²,

Moschetta³

et al. 2022

Chin Clin Oncol

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Background and Objective: Tumors of the ampulla of Vater are a rare set of lesions that arise at the confluence of the common bile duct (CBD) and the pancreatic duct. They can be benign or malignant, often not easy to discriminate before treatment. Malignant tumors have low chances of survival (overall 5-year survival between 0% and 60%) and surgery is still the only curative option. Prognostic factors are being investigated to tailor therapeutic approach and improve outcomes. Due to their location in a complex anatomical region, all treatment options are challenging and associated with relevant morbidity. In this review we discuss different excisional techniques for the treatment of ampullary tumors (AT).Methods: A review of medical databases (PubMed and Google Scholar) was conducted selecting most relevant articles in English language without a specific timeframe. After first selection, most relevant citations were identified through snowballing.Key Content and Findings: Pancreatoduodenectomy (PD) is the gold standard in malignant tumors, achieving the most radical treatment, at the price of worse perioperative morbidity/mortality and quality of life. Trans-duodenal ampullectomy (TDA) was developed before endoscopic resection (ER) and maintains a role only in selected patients. ER is now the first choice for benign lesions and expanding towards early stages malignant AT.Conclusions: Pancreatodudenectomy remains the best option for the radical excision of malignant AT, recently being offered also via minimally invasive approach. However, in early-stage malignant tumors, ER is gaining importance with foreseeable further expansion. Transduodenal ampullectomy still has a role in selected patients, such as unfit for PD when ER is not possible mainly due to anatomical abnormalities.

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Prognostic factors and benefits of adjuvant therapy for ampullary cancer following pancreatoduodenectomy: A systematic review and meta-analysis

Cited by 8 publications

References 66 publications

Survival after curative pancreaticoduodenectomy for ampullary adenocarcinoma in a South American population: A retrospective cohort study

Survival after curative pancreaticoduodenectomy for ampullary adenocarcinoma in a South American population: A retrospective cohort study

Ampullary Adenocarcinoma, Version 1.2023, NCCN Clinical Practice Guidelines in Oncology

From endoscopic resection to pancreatoduodenectomy: a narrative review of treatment modalities for the tumors of the ampulla of Vater

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