Clinicopathologic features and prognosis of duodenal adenocarcinoma and comparison with ampullary and pancreatic ductal adenocarcinoma

Abstract

Because of the rarity of duodenal adenocarcinoma (DAC), the clinicopathologic features and prognostication data for DAC are limited. There are no published studies directly comparing the prognosis of DAC to that of ampullary adenocarcinoma (AA) and of pancreatic ductal adenocarcinoma (PDA) after resection. In this study, we examined the clinicopathologic features of 68 patients with DAC, 92 patients with AA, and 126 patients with PDA who underwent resection. Patient clinicopathologic and survival information were extracted from medical records. Statistical analysis was performed using Statistical Package for the Social Sciences with 2-sided significance level of .05. Patients with DAC had higher American Joint Committee on Cancer (AJCC) stage than AA patients (P = .001). Lymph node metastasis (P = .013) and AJCC stage (P = .02) correlated with overall survival in DAC patients. Patients with DAC or AA had lower frequencies of lymph node metastasis and positive margin and better survival than those with PDA (P < .05). However, no differences in nodal metastasis, margin status, or survival were observed between DAC patients and those with AA. Our study showed that lymph node metastasis and AJCC stage are important prognostic factors for overall survival in DAC patients. Patients with DAC had less frequent nodal metastasis and better prognosis than those with PDA. There was no significant difference in prognosis between DAC and AA.

Keywords: Ampullary adenocarcinoma; Duodenal adenocarcinoma; Pancreatic cancer; Prognosis; Survival.

Figure 1

Representative micrographs showing a moderately differentiated adenocarcinoma (A) and a moderately differentiated mucinous adenocarcinoma (B) of duodenum. Hematoxylin & eosin (H & E) stain, original magnification: 200×.

Figure 2

Kaplan-Meier survival curves of overall survival in patients with duodenal adenocarcinoma stratified by the lymph node metastasis (A) and AJCC stages (B). Patients with lymph node metastasis or AJCC stage III or IV disease had shorter overall survival than those who were negative for lymph metastasis or those who had AJCC stage I or II disease.

Figure 3

Kaplan-Meier survival curves of overall survival in patients with duodenal adenocarcinoma in comparison with ampullary adenocarcinoma and pancreatic ductal adenocarcinoma among all patients (A) and those with stages II and III only (B). Patients with pancreatic ductal adenocarcinoma had shorter overall survival than those with either duodenal adenocarcinoma or ampullary adenocarcinoma (p=0.001). However, there is no significant difference in overall survival between the patients with duodenal adenocarcinoma and those with ampullary adenocarcinoma (p>0.05). C. Kaplan-Meier survival curves of overall survival in patients with periampullary duodenal adenocarcinoma (N=40) compared to ampullary adenocarcinoma (p=0.31).