Clinicopathologic features and prognosis of duodenal adenocarcinoma and comparison with ampullary and pancreatic ductal adenocarcinoma

Abstract

Due to the rarity of duodenal adenocarcinoma (DAC), the clinicopathologic features and prognostication data for DAC are limited. There are no published studies directly comparing the prognosis of DAC to ampullary adenocarcinoma (AA) and pancreatic ductal adenocarcinoma (PDA) after resection. In this study, we examined the clinicopathologic features of 68 patients with DAC, 92 patients with AA and 126 patients with PDA, who underwent resection. Patient clinicopathologic and survival information were extracted from medical records. Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) with two-sided significance level of 0.05. Patients with DAC had higher American Joint Committee on Cancer (AJCC) stage than AA patients (P=0.001). Lymph node metastasis (P=0.013) and AJCC stage (P=0.02) correlated with overall survival in DAC patients. Patients with DAC or AA had lower frequencies of lymph node metastasis and positive margin and better survival than those with PDA (P<0.05). However, no differences in nodal metastasis, margin status or survival were observed between DAC patients and those with AA. Our study showed that lymph node metastasis and AJCC stage are important prognostic factors for overall survival in DAC patients. Patients with DAC had less frequent nodal metastasis and better prognosis than those with PDA. There was no significant difference in prognosis between DAC and AA.

Non-ampullary–duodenal carcinomas: clinicopathologic analysis of 47 cases and comparison with ampullary and pancreatic adenocarcinomas

“…This figure is similar to the studies that focused on well-characterized cases of non-ampullary-duodenal carcinomas, where it is~55% with a range of 54-60% in the largest institutional series on this topic. 5,10,17,18 We found that the presence of gastric-pancreatobiliary histology may be associated with more aggressive behavior (although this did not reach statistical significance), which was also reported by others 10,16 and thus it is important to attempt to recognize and report this lineage (no matter the quantity) in any non-ampullary-duodenal carcinoma case.…”

“…3 For non-ampullary-duodenal carcinomas, the literature reveals conflicting results, largely because they have often been analyzed with ampullary or other intestinal cancers. Recent studies are indicating that they may in fact be fairly similar to 'ampullary cancers', 4,5 but many of their characteristics have not been fully elucidated.…”

Duodenal localization is a negative predictor of survival after small bowel adenocarcinoma resection: A population‐based, propensity score‐matched analysis

“…However, in patients with a high risk for small bowel cancer (patients suffering from familial adenomatous polyposis (FAP) or Lynch syndrome (HNPCC)), a screening using EGD might be beneficial . Although no improvement in prognosis has been observed with (neo‐)adjuvant therapies, such as chemoradiation or chemotherapy, these additional therapies should be evaluated further because the prognosis of duodenal cancer is very dismal.…”

A case of duodenal adenocarcinoma masquerading as acute cholecystitis and biliary pancreatitis

“…However, associations with hereditary or inflammatory conditions have been reported. [6,7] Periampullary adenocarcinoma is categorized into four types based on its origin: pancreatic adenocarcinoma, adenocarcinoma of the ampulla of Vater, distal bile duct adenocarcinoma, and DAC which represents the least common type. [2] Yeo et al identified 242 patients that underwent pancreaticoduodenal resection for periampullary adenocarcinoma from 1970 through 1997.…”

“…Patients with DAC and AA had less frequent nodal metastasis and better prognosis than those with PDA, and the overall 5-year survival for DAC patients was 55.9%. [6] 4. CONCLUSIONS DAC is rare.…”