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. 2013 Sep;24(9):2349-53.
doi: 10.1093/annonc/mdt191. Epub 2013 May 22.

A retrospective study of ampullary adenocarcinomas: overall survival and responsiveness to fluoropyrimidine-based chemotherapy

Z-Q Jiang  1 , G Varadhachary, X Wang, S Kopetz, J E Lee, H Wang, R Shroff, M Katz, R A Wolff, J Fleming, M J Overman
Affiliations

A retrospective study of ampullary adenocarcinomas: overall survival and responsiveness to fluoropyrimidine-based chemotherapy

Z-Q Jiang et al. Ann Oncol. 2013 Sep.

Abstract

Background: Whether carcinomas of the ampulla of Vater should be classified with biliary tract tumors and treated in a similar manner remains unknown. We sought to compare the outcomes of similarly staged periampullary adenocarcinomas (AAs) and analyze the chemotherapy responsiveness of AAs.

Patients and methods: A total of 905 patients with resected periampullary adenocarcinomas were identified from a prospective surgical registry from 1988 to 2010. A second cohort of 64 metastatic AA patients from 1992 to 2009 who received either front-line fluoropyrimidine-based or gemcitabine-based chemotherapy was also identified.

Results: Overall survival (OS) for AAs was similar to survival with duodenal adenocarcinomas, but was significantly different from both extrahepatic biliary and pancreatic adenocarcinomas (P < 0.001 for each comparison). In multivariate analysis, AAs had a significantly improved OS in comparison with extrahepatic biliary adenocarcinomas (HR = 1.97, P = 0.006). Fluoropyrimidine-based as opposed to gemcitabine-based chemotherapy for metastatic AAs resulted in a significant improvement in time to progression (P = 0.001) but only a trend toward benefit for OS (P = 0.07) in multivariate analysis.

Conclusions: Differences in the natural history of ampullary and extrahepatic biliary adenocarcinomas exist. Analyses of metastatic ampullary adenocarcinomas suggest that fluoropyrimidine-based chemotherapy may represent a more appropriate front-line chemotherapy approach.

Keywords: ampullary adenocarcinomas; chemotherapy; fluoropyrimidine; gemcitabine; periampullary.

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Figures

Figure 1.
Figure 1.
Overall survival (OS) for 905 resected periampullary adenocarcinoma cases stratified by tumor type: (A) all, (B) Lymph node-positive cases, (C) Lymph node-negative cases, (D) T1-T2 cases, (E) T3-T4 cases.
Figure 2.
Figure 2.
Outcomes for 64 metastatic ampullary adenocarcinoma patients treated with either first-line fluoropyrimidine-based or gemcitabine-based chemotherapy: (A) time to progression (TTP) and (B) OS.
See this image and copyright information in PMC

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