Identification of patients at high risk for recurrence in carcinoma of the ampulla of Vater: Analysis in 460 patients

Masato Narita; Etsuro Hatano; Koji Kitamura; Ken Fukumitsu; Hirohisa Kitagawa; Yuhei Hamaguchi; Takefumi Yazawa; Hiroaki Terajima; Kazuhiko Kitaguchi; Toshihiko Hata; Kyoto University Hepato‐Biliary Pancreatic surgery Study Group (KUHBPS)

doi:10.1002/ags3.12764

Identification of patients at high risk for recurrence in carcinoma of the ampulla of Vater: Analysis in 460 patients

Ann Gastroenterol Surg. 2023 Dec 26;8(2):190-201. doi: 10.1002/ags3.12764. eCollection 2024 Mar.

Affiliations

¹ Department of Surgery National Hospital Organization Kyoto Medical Center Kyoto Japan.
² Department of Surgery Kobe City Medical Center General Hospital Kobe Japan.
³ Department of Surgery, Graduate School of Medicine Kyoto University Kyoto Japan.
⁴ Department of Surgery Hyogo Prefectural Amagasaki General Medical Center Amagasaki Japan.
⁵ Department of Surgery Kyoto Katsura Hospital Kyoto Japan.
⁶ Department of Surgery Kurashiki Central Hospital Kurashiki Japan.
⁷ Department of Surgery Japanese Red Cross Osaka Hospital Osaka Japan.
⁸ Department of Surgery Shiga General Hospital Shiga Japan.
⁹ Department of Surgery Kitano Hospital Osaka Japan.
¹⁰ Department of Surgery Japanese Red Cross Otsu Hospital Otsu Japan.
¹¹ Department of Surgery Kobe City Medical Center West Hospital Kobe Japan.

Abstract

Aim: Carcinoma of the ampulla of Vater (CAV) shows a favorable prognosis compared to that with the other periampullary tumors, while some cases have a poor prognosis. The aims of the present study are to clarify the clinicopathological factors associated with poor recurrence-free survival (RFS) in patients with CAV after curative resection and to validate the usefulness of adjuvant chemotherapy (AC).

Patients: The study design is a multicenter retrospective cohort study. Patients with CAV who underwent pancreaticoduodenectomy between January 2008 and December 2020 at 26 hospitals were analyzed. The 30 clinicopathological factors were evaluated. A propensity score matching (PSM) was used to compare between patients with and without AC.

Results: Finally, 460 patients were analyzed. Median duration of follow-up was 47.2 months. Twenty-one prognostic factors associated with poor RFS were identified by univariate analysis. In multivariate analysis, aged ≥71, tumor diameter ≥12 mm, pT2 or higher stage (pT≥2), portal vein invasion (PV+), venous invasion(V+), and node positive disease (pN+) were independent prognostic factors for poor RFS. Out of 80 patients who received AC, 63 patients were assigned to analysis for PSM. The results showed no beneficial effect of AC on RFS. The preoperative factors potentially predicting pT≥2, V+, and/or N+ were at least one of following; (1) CA19-9 > 37 IU/mL, (2) ulcerative or mixed type appearance, (3) except for well-differentiated tumor, or (4) except for intestinal subtype of histology.

Conclusions: Aged ≥71, tumor diameter ≥12 mm, pT≥2, PV+, V+, and pN+ were independent prognostic factors for poor RFS in patients with CAV. An additional therapeutic strategy may be desirable in CAV patients at high risk for recurrence.

Keywords: adjuvant chemotherapy; ampullary cancer; neoadjuvant chemotherapy; overall survival; prognosis.