Perineural Invasion is a Strong Prognostic Moderator in Ampulla of Vater Carcinoma

Abstract

Objective Ampulla of Vater carcinoma (AVC) has a broad spectrum of different prognoses. As such, new moderators of survival are urgently needed. We aimed at clarifying the prognostic role of perineural invasion in AVC. Methods Using PubMed and SCOPUS databases, we conducted the first systematic review and meta-analysis on this topic. Results Analyzing 29 articles for a total of 2379 patients, we found that the presence of perineural invasion increased the risk of all-cause mortality more than 2 times (relative risk [RR], 2.07; 95% confidence interval [CI], 1.78–2.42 [P < 0.0001]; hazard ratio [HR], 2.72; 95% CI, 1.86–3.97 [P < 0.0001]), of cancer-specific mortality more than 6 times (RR, 6.12; 95% CI, 3.25–11.54 [P < 0.0001]; HR, 6.59; 95% CI, 2.29–3.49 [P < 0.0001]), and of recurrence more than 2 times (RR, 2.63; 95% CI, 1.89–3.67 [P < 0.0001]; HR, 2.54; 95% CI, 1.24–5.21 [P = 0.01]). Conclusions Perineural invasion is strongly associated with a poorer prognosis in AVC, influencing both survival and risk of recurrence. It should be reported in the final pathology report and should be taken into account by future oncologic staging systems, identifying a group of AVC with a more malignant biological behavior.

The pathohistological subtype strongly predicts survival in patients with ampullary carcinoma

“…In a meta-analysis by Luchini et al . perineural invasion was strongly associated with a poorer prognosis in patients with ampullary cancer 26 . This behavior is based on the origin of the epithelium, which arises from the distal bile duct, distal pancreatic duct, or the common bile duct of the ampulla.…”

Das Ampullenkarzinom – prognostische und therapeutische Unterschiede zum duktalen Adenokarzinom des Pankreas

“…Mehrere Faktoren sind dabei für die ungünstigere Prognose des pankreatobiliären Subtyps verantwortlich. So zeigt der pankreatobiliäre Typ eine signifikant häufigere Invasion von Lymphknoten und der Perineuralscheide [2,9]. Darüber hinaus liegt bei Diagnosestellung des pankreatobiliären Subtyps häufiger ein fortgeschrittenes T-Stadium vor [16].…”

Ampullary Carcinoma: An Overview of a Rare Entity and Discussion of Current and Future Therapeutic Challenges

“…From a histological point of view, intestinal-type AC is usually characterized by the presence of a non-invasive component of duodenal adenoma, and the morphology of this subtype has been suggested to be similar to that of colorectal cancer, with central necrosis and cribriform or tubular glands [ 13 , 14 ]. Classically, intestinal-type ACs present a smaller invasive component and less frequent perineural and lymphovascular invasion, something that has been related to a better prognosis compared to pancreaticobiliary-type ACs [ 15 , 16 ]. In terms of immunohistochemistry, intestinal-type AC frequently presents the expression of cytokeratin 20 (CK20), mucin 2 (MUC2), caudal-related homeodomain transcription factor 2 (CDX2) and other classically intestinal markers [ 15 , 16 ]; conversely, the pancreaticobiliary subtype has important immunohistochemical analogies with distal cholangiocarcinoma and pancreatic adenocarcinoma, due to the presence of abundant desmoplastic stroma and atypical cells [ 15 , 16 , 17 ], and the frequent immunohistochemical expression of mucin 1 (MUC1), cytokeratin 7 (CK7), and mucin 5AC (MUC5AC) [ 15 , 16 , 17 ].…”