Prognostic Impact of Intra-Ampullary Papillary-Tubular Neoplasm versus Flat Dysplasia as Precursor Lesions of Ampullary Adenocarcinoma

Abstract

<b><i>Background:</i></b> The aim of this study is to compare the prognostic impact of 2 precursor lesions of ampullary adenocarcinoma, intra-ampullary papillary-tubular neoplasm (IAPN) and flat dysplasia (FD). <b><i>Methods:</i></b> From December 1994 to December 2012, a total of 359 patients underwent curative surgery for ampullary adenocarcinoma. <b><i>Results:</i></b> The precursor lesions were IAPNs in 134 (37.3%) patients and FD in the other 225 (62.7%) patients. The FD group had more aggressive tumor biology with advanced T stage (<i>p</i> = 0.002), nodal involvement (<i>p</i> < 0.001), poor differentiation (<i>p</i> < 0.001), perineural and lymphovascular invasion (<i>p</i> < 0.001), and pancreatobiliary or mixed subtype (<i>p</i> < 0.001). Five-year overall survival rates were 71.1% in the IAPN group and 51.4% in the FD group (<i>p</i> = 0.002), respectively. Five-year disease-free survival rates were 69.7% in the IAPN group and 49.6% in the FD group (<i>p</i> < 0.001), respectively. The recurrence rate was also higher in the FD group (49.8 vs. 30.6%; <i>p</i> < 0.001). On multivariate analysis, higher levels of tumor markers including CEA and CA19-9, lymph node metastasis, poorly differentiated histology, and perineural invasion were negative predictive factors for survival. Higher levels of CEA and CA19-9, lymphovascular invasion, and FD were independent prognostic factors for recurrence. <b><i>Conclusion:</i></b> FD was significantly associated with worse prognosis and a greater tendency toward advanced disease. Further studies are needed to clarify the impacts of these precursor lesions.

Transduodenal surgical ampullectomy for intra-ampullary papillary tubular neoplasm (IAPN): A case report

“…CECT abdomen is helpful to stage the disease. The prognosis for IAPNs (both noninvasive and invasive cases considered) is significantly better than that of other invasive carcinomas of the ampulla and pancreatic ductal adenocarcinoma [2] , [5] .…”

Small Bowel Epithelial Precursor Lesions: A Focus on Molecular Alterations

“…These neoplasms are predominantly preinvasive but are often (78%) associated with an invasive adenocarcinoma component [ 64 ] which drives prognosis (5-year survival of non-invasive vs invasive lesions: 100% vs. 45%). Importantly, invasive carcinomas associated with IAPN have a better survival compared to cancers associated with flat dysplasia (5-year disease free survival IAPN associated vs flat dysplasia associated cancers: 70% vs. 50%) [ 65 ]. No specific information on the molecular background of this subtype of pre-invasive lesion is yet available.…”