The pathohistological subtype strongly predicts survival in patients with ampullary carcinoma

Abstract

Ampullary cancer represents approximately 6% of the malignant periampullary tumors. An early occurrence of symptoms leads to a 5-year survival rate after curative surgery of 30 to 67%. In addition to the tumor stage, the immunohistological subtypes appear to be important for postoperative prognosis. The aim of this study was to analyze the different subtypes regarding their prognostic relevance. A total of 170 patients with ampullary cancer were retrospectively analyzed between 1999 until 2016 after pancreatic resection. Patients were grouped according to their pathohistological subtype of ampullary cancer (pancreatobiliary, intestinal, mixed). Characteristics among the groups were analyzed using univariate and multivariate models. Survival probability was analyzed by the Kaplan-Meier method. An exact subtyping was possible in 119 patients. A pancreatobiliary subtype was diagnosed in 69 patients (58%), intestinal in 41 patients (34.5%), and a mixed subtype in 9 patients (7.6%). Survival analysis showed a significantly worse 5-year survival rate for the pancreatobiliary subtype compared with the intestinal subtype (27.5% versus 61%, p < 0.001). The mean overall survival of patients with pancreatobiliary, intestinal, and mixed subtype was 52.5, 115 and 94.7 months, respectively ( p < 0.001). The pathohistological subtypes of ampullary cancer allows a prediction of the postoperative prognosis.

Clinicopathological Prognostic Factors and Chemotherapeutic Outcome for Two Histopathological Types of Ampulla of Vater Adenocarcinoma

“…For instance, Vilhordo and colleagues ( 9 ) discovered the four prognostic factors of lymph node metastasis number, lymph node ratio (LNR), lymphovascularization, and differentiation grade of invasion. Numerous reports ( 10 , 11 ) have also reported that the histological type is associated with overall survival, implicating poor prognosis for the pancreaticobiliary-type, as observed in our cohort.…”

Periampulläre Tumoren: Epidemiologie, Klassifikation und Diagnostik

“…In Deutschland ist der intestinale Subtyp mit 34,5 % seltener, ein pankreatobiliärer Subtyp liegt in 58 % der Fälle vor. In 7,6 % der Fälle liegt ein gemischter Typ vor [23]. Ähnliche Ergebnisse ergab eine kleine Serie aus Serbien mit 37 Patienten mit einem Anteil für den pankreatobiliären Subtyp von 62 % und 35 % für den intestinalen Subtyp, in 3 % der Fälle lag ein gemischter Typ vor [24].…”

“…Das Langzeitüberleben ist bei Patienten mit intestinalem Subtyp am besten, gefolgt vom gemischten Typ. Patienten mit pankreatobiliärem Subtyp haben die schlechteste Prognose [21,23,24,28]. Die immunhistochemische Differenzierung der histologischen Subtypen ist demzufolge sowohl für die Wahl der adjuvanten Chemotherapie als auch für die Prognose relevant [27].…”

Tissue microarray-chip featuring computerized immunophenotypical characterization more accurately subtypes ampullary adenocarcinoma than routine histology

“…Due to these considerations, an accurate histological classification of AACs is crucial for management by a tailored therapeutic strategy and valid prognostic asse-ssment[ 32 , 33 ].…”