Clinico-pathological correlates and survival outcomes in 214 resected ampullary adenocarcinomas – are outcomes different in intestinal and pancreatobiliary subtypes with adjuvant gemcitabine?

Abstract

Background: Evidence suggests that intestinal type (IT) and pancreatobiliary (PB) subtypes of ampullary adenocarcinoma (AC) may have different outcomes. The current study evaluated differences in outcomes between these subtypes and the benefit of adjuvant chemotherapy (AT). Methods: A prospectively maintained database of patients who underwent upfront resection for AC from January 2012 to March 2016 was conducted. A dedicated pathologist reported differentiation between IT and PB subtypes. Results: 214 patients were included for analysis: 105 PB subtype and 109 IT subtype. With a median follow up of 46.3 months, estimated 4 year overall survival (OS) was 65.8%. In patients with stage II-III disease, lymph-node ratio (LNR) < 0.2 [Not reached (NR) vs. 30.72 months; p = 0.002], absence of perineural invasion (PNI) (NR vs. 31.61 months; p = 0.032) and AT (gemcitabine-96.1%) (NR vs. 22.28 months) were prognostic for superior OS. There was no difference in OS between IT and PB subtypes, but both subtypes with stage II-III disease benefitted from AT statistically as compared to observation (IT: NR vs. 28.62 months; PB: 18.46 months vs. 58.09 months; p < 0.001). Conclusions: AC-IT and AC-PB did not have a different OS when treated with resection and adjuvant gemcitabine, though adjuvant therapy benefitted both subtypes individually.

Prognostic significance of preoperative Naples prognostic score on short- and long-term outcomes after pancreatoduodenectomy for ampullary carcinoma

“…Compared with other periampullary tumors, the clinical symptoms of ampullary cancer usually occur earlier, which may explain the better prognosis. As reported previously (2,4,5), the 5-year overall survival (OS) rate of ampullary carcinomas is approximately 40-65% in resectable patients. Studies have suggested that many factors affect the prognosis of ampullary cancer, including the TNM stage, tumor subtypes, surgical margins, adjuvant chemotherapy (2-4,7); however, it remains necessary and urgent to study additional prognostic factors to accurately predict the prognosis of ampullary cancer.…”

“…To the best of our knowledge, this study is the first report to identify the prognostic significance of NPS on short-and long-term outcomes in patients undergoing PD for ampullary carcinoma. The clinical outcomes of patients with malignant tumors after curative surgery are associated with the tumor characteristics, surgical factors, and host-related factors (2,25,26). Among these factors, immune-nutritional status is widely recognized as a critical host-related factor.…”

“…Ampullary carcinoma is a relatively rare malignant tumor representing approximately 8% of all malignant periampullary tumors and accounting for 30-40% of surgically resectable periampullary cancers (1)(2)(3)(4)(5)(6). Compared with other periampullary tumors, the clinical symptoms of ampullary cancer usually occur earlier, which may explain the better prognosis.…”

Clinical impact of ampulla of Vater cancer subtype classification based on immunohistochemical staining

“…Therefore, in the present study, we assessed the duration for which patients remained free from cancer recurrence, providing insights into the potential impact of classification on disease progression and treatment effectiveness. Recently, the approaches of administering gemcitabine-based therapies for PB-type tumors and fluorouracil-based therapies for INT-type tumors have been increasingly favored [ 24 – 26 ]. However, the present study’s retrospective nature made further analysis of the relationship between subtypes and chemotherapy impossible.…”

Ampullary Adenocarcinoma: A Review of the Mutational Landscape and Implications for Treatment

“…A histologic subtype was not associated with survival in a multivariate Cox regression (p = 0.175) [36]. Additionally, several institutional analyses have failed to identify a statistically significant difference in survival between the two subtypes in resected patients [37,38]. Ultimately, histomorphologic subtypes pro-vide simple categories for classification, but the utility of such a biomarker in guiding post-surgical surveillance or treatment decisions is limited given this variability.…”