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Multicenter Study
. 2020 Dec;272(6):1086-1093.
doi: 10.1097/SLA.0000000000003177.

Histopathologic Predictors of Survival and Recurrence in Resected Ampullary Adenocarcinoma: International Multicenter Cohort Study

Alma L Moekotte  1 , Sanne Lof  1 , Stijn Van Roessel  2 , Martina Fontana  3 , Stephan Dreyer  4   5 , Alaaeldin Shablak  6 , Fabio Casciani  3 , Vasileios K Mavroeidis  7 , Stuart Robinson  8 , Khalid Khalil  9 , George Gradinariu  10 , Nicholas Mowbray  11 , Bilal Al-Sarireh  11 , Giuseppe Kito Fusai  10 , Keith Roberts  9 , Steve White  8 , Zahir Soonawalla  7 , Nigel B Jamieson  5 , Roberto Salvia  3 , Marc G Besselink  2 , Mohammed Abu Hilal  1
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Free article
Multicenter Study

Histopathologic Predictors of Survival and Recurrence in Resected Ampullary Adenocarcinoma: International Multicenter Cohort Study

Alma L Moekotte et al. Ann Surg. 2020 Dec.
Free article

Abstract

Objective: The aim of the study was to define histopathologic characteristics that independently predict overall survival (OS) and disease-free survival (DFS), in patients who underwent resection of an ampullary adenocarcinoma with curative intent.

Summary background data: A broad range of survival rates have been described for adenocarcinoma of the ampulla of Vater, presumably due to morphological heterogeneity which is a result of the different epitheliums ampullary adenocarcinoma can arise from (intestinal or pancreaticobiliary). Large series with homogenous patient selection are scarce.

Methods: A retrospective multicenter cohort analysis of patients who underwent pancreatoduodenectomy for ampullary adenocarcinoma in 9 European tertiary referral centers between February 2006 and December 2017 was performed. Collected data included demographics, histopathologic details, survival, and recurrence. OS and DFS analyses were performed using Kaplan-Meier curves and Cox proportional hazard models.

Results: Overall, 887 patients were included, with a mean age of 66 ± 10 years. The median OS was 64 months with 1-, 3-, 5-, and 10-year OS rates of 89%, 63%, 52%, and 37%, respectively. Histopathologic subtype, differentiation grade, lymphovascular invasion, perineural invasion, T-stage, N-stage, resection margin, and adjuvant chemotherapy were correlated with OS and DFS. N-stage (HR = 3.30 [2.09-5.21]), perineural invasion (HR = 1.50 [1.01-2.23]), and adjuvant chemotherapy (HR = 0.69 [0.48-0.97]) were independent predictors of OS in multivariable analysis, whereas DFS was only adversely predicted by N-stage (HR = 2.65 [1.65-4.27]).

Conclusions: Independent predictors of OS in resected ampullary cancer were N-stage, perineural invasion, and adjuvant chemotherapy. N-stage was the only predictor of DFS. These findings improve predicting survival and recurrence after resection of ampullary adenocarcinoma.

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References

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