Background:
The prognostic impact of pathologic response to preoperative therapy in patients with duodenal adenocarcinoma (DA) and ampullary adenocarcinoma (AMPA) has not been established.
Methods:
A retrospective review of 266 patients who underwent curative resection for DA (n=97) or AMPA (n=169) during 1993–2015 was performed. For patients who underwent preoperative therapy, pathologic response was systematically evaluated and classified as major (0%−49% of viable residual tumor cells) or minor (≥50% of viable residual tumor cells). Univariable and multivariable analyses were performed to identify predictors of pathologic response and disease-specific survival (DSS).
Results:
In the 79 patients treated with preoperative therapy (DA n=34; AMPA n=45), concomitant use of radiation (67/79, 80%) was the sole independent predictor of major pathologic response (odds ratio: 8.17, 95% CI: 1.85–58.2, P=0.005). Patients with major pathologic response had a better 5-year DSS rate than patients with minor pathologic response (DA, 65% vs. 25%, P=0.028; AMPA, 85% vs. 43%, P=0.016). On multivariable analysis of DSS in the 79 patients who underwent preoperative therapy, major pathologic response was the sole predictor of improved DSS (hazard ratio: 2.88, 95% CI: 1.41–5.98, P=0.004). On multivariable analysis of DSS in the entire cohort, pathologic stage ≤II was the sole predictor of better DSS.
Conclusion:
Major pathologic response to preoperative therapy predicted improved DSS after resection of DA and AMPA and might represent a new prognosticator after resection of DA and AMPA.