Identification of patients at high risk for recurrence in carcinoma of the ampulla of Vater: Analysis in 460 patients
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 (R...
| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2024-03-01
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| Series: | Annals of Gastroenterological Surgery |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/ags3.12764 |
| _version_ | 1797272602127892480 |
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| author | Masato Narita Etsuro Hatano Koji Kitamura Ken Fukumitsu Hirohisa Kitagawa Yuhei Hamaguchi Takefumi Yazawa Hiroaki Terajima Kazuhiko Kitaguchi Toshihiko Hata the Kyoto University Hepato‐Biliary Pancreatic surgery Study Group (KUHBPS) |
| author_facet | Masato Narita Etsuro Hatano Koji Kitamura Ken Fukumitsu Hirohisa Kitagawa Yuhei Hamaguchi Takefumi Yazawa Hiroaki Terajima Kazuhiko Kitaguchi Toshihiko Hata the Kyoto University Hepato‐Biliary Pancreatic surgery Study Group (KUHBPS) |
| author_sort | Masato Narita |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-03-07T14:31:42Z |
| format | Article |
| id | doaj.art-259429e2c2114d588308d70472d9e9de |
| institution | Directory Open Access Journal |
| issn | 2475-0328 |
| language | English |
| last_indexed | 2024-03-07T14:31:42Z |
| publishDate | 2024-03-01 |
| publisher | Wiley |
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| series | Annals of Gastroenterological Surgery |
| spelling | doaj.art-259429e2c2114d588308d70472d9e9de2024-03-06T03:47:04ZengWileyAnnals of Gastroenterological Surgery2475-03282024-03-018219020110.1002/ags3.12764Identification of patients at high risk for recurrence in carcinoma of the ampulla of Vater: Analysis in 460 patientsMasato Narita0Etsuro Hatano1Koji Kitamura2Ken Fukumitsu3Hirohisa Kitagawa4Yuhei Hamaguchi5Takefumi Yazawa6Hiroaki Terajima7Kazuhiko Kitaguchi8Toshihiko Hata9the Kyoto University Hepato‐Biliary Pancreatic surgery Study Group (KUHBPS)Department of Surgery National Hospital Organization Kyoto Medical Center Kyoto JapanDepartment of Surgery, Graduate School of Medicine Kyoto University Kyoto JapanDepartment of Surgery Hyogo Prefectural Amagasaki General Medical Center Amagasaki JapanDepartment of Surgery Kyoto Katsura Hospital Kyoto JapanDepartment of Surgery Kurashiki Central Hospital Kurashiki JapanDepartment of Surgery Japanese Red Cross Osaka Hospital Osaka JapanDepartment of Surgery Shiga General Hospital Shiga JapanDepartment of Surgery Kitano Hospital Osaka JapanDepartment of Surgery Japanese Red Cross Otsu Hospital Otsu JapanDepartment of Surgery Kobe City Medical Center West Hospital Kobe JapanAbstract 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.https://doi.org/10.1002/ags3.12764adjuvant chemotherapyampullary cancerneoadjuvant chemotherapyoverall survivalprognosis |
| spellingShingle | Masato Narita Etsuro Hatano Koji Kitamura Ken Fukumitsu Hirohisa Kitagawa Yuhei Hamaguchi Takefumi Yazawa Hiroaki Terajima Kazuhiko Kitaguchi Toshihiko Hata the Kyoto University Hepato‐Biliary Pancreatic surgery Study Group (KUHBPS) Identification of patients at high risk for recurrence in carcinoma of the ampulla of Vater: Analysis in 460 patients Annals of Gastroenterological Surgery adjuvant chemotherapy ampullary cancer neoadjuvant chemotherapy overall survival prognosis |
| title | Identification of patients at high risk for recurrence in carcinoma of the ampulla of Vater: Analysis in 460 patients |
| title_full | Identification of patients at high risk for recurrence in carcinoma of the ampulla of Vater: Analysis in 460 patients |
| title_fullStr | Identification of patients at high risk for recurrence in carcinoma of the ampulla of Vater: Analysis in 460 patients |
| title_full_unstemmed | Identification of patients at high risk for recurrence in carcinoma of the ampulla of Vater: Analysis in 460 patients |
| title_short | Identification of patients at high risk for recurrence in carcinoma of the ampulla of Vater: Analysis in 460 patients |
| title_sort | identification of patients at high risk for recurrence in carcinoma of the ampulla of vater analysis in 460 patients |
| topic | adjuvant chemotherapy ampullary cancer neoadjuvant chemotherapy overall survival prognosis |
| url | https://doi.org/10.1002/ags3.12764 |
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