Oncologic outcomes in resected ampullary cancer: Relevance of histologic subtype and adjuvant chemotherapy

Am J Surg. 2021 Jun;221(6):1128-1134. doi: 10.1016/j.amjsurg.2021.04.001. Epub 2021 Apr 8.

Abstract

Background: Outcomes in ampullary cancer (AC) may differ by pathologic subtype. No guidelines exist for the administration of adjuvant therapy (AT). We sought to evaluate the effect of subtype and AT on survival.

Methods: An institutional review of patients undergoing resection for AC from 2008-17 was performed. Recurrence-free (RFS) and overall survival (OS) were assessed by Kaplan-Meier and Cox proportional hazards modeling.

Results: Of 53 patients, two-thirds (62%) were stage III. Histologic subtype was evenly split between intestinal and pancreatobiliary (43% and 40%). Half of patients received AT. RFS and OS were 25 (95% CI 16-32) and 41 (CI 22-60) months, respectively, without significant difference by subtype. Stage II/III disease was associated with worse OS (HR 3.7, P = 0.03), which was improved with receipt of AT (HR 0.44, P < 0.05).

Conclusion: Stage is the primary determinant of survival in AC, which may be improved with AT.

Keywords: Adjuvant therapy; Ampullary cancer; Cancer outcomes; Hepatopancreatobiliary surgery; Pancreatoduodenectomy.

MeSH terms

  • Adenocarcinoma / drug therapy
  • Adenocarcinoma / pathology
  • Adenocarcinoma / surgery*
  • Adult
  • Aged
  • Aged, 80 and over
  • Ampulla of Vater* / pathology
  • Ampulla of Vater* / surgery
  • Chemotherapy, Adjuvant / methods*
  • Combined Modality Therapy
  • Common Bile Duct Neoplasms / drug therapy
  • Common Bile Duct Neoplasms / pathology
  • Common Bile Duct Neoplasms / surgery*
  • Disease-Free Survival
  • Female
  • Humans
  • Kaplan-Meier Estimate
  • Male
  • Middle Aged
  • Neoplasm Staging
  • Proportional Hazards Models
  • Retrospective Studies
  • Survival Analysis
  • Treatment Outcome