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. 2024 Oct 14.
doi: 10.1097/SLA.0000000000006563. Online ahead of print.

Population-Based Cohort Study on Treatment and Overall Survival of Patients Clinically Diagnosed With T1 Ampullary Cancer

Anouk J de Wilde  1 , Evelien J M de Jong  2 , Marco J Bruno  3 , Marc G Besselink  4   5 , Lydia G M van der Geest  6 , Sandra M E Geurts  2 , Bas Groot Koerkamp  7 , Ignace H J T de Hingh  2   8 , Vincent E de Meijer  9 , Razvan L Miclea  10 , Jan-Werner Poley  11 , Iryna V Samarska  12 , Hjalmar C van Santvoort  13 , Martijn W J Stommel  14 , Rogier P Voermans  5   15 , Steven W M Olde Damink  1   16 , Judith de Vos-Geelen  2 , Stefan A W Bouwense  1   16 ; Dutch Pancreatic Cancer Group
Affiliations

Population-Based Cohort Study on Treatment and Overall Survival of Patients Clinically Diagnosed With T1 Ampullary Cancer

Anouk J de Wilde et al. Ann Surg. .

Abstract

Objective: To evaluate treatment outcomes, overall survival (OS), and prognostic factors for OS in patients diagnosed with T1 ampullary cancer.

Background: Ampullary cancer is a rare gastrointestinal malignancy with limited data from large cohorts, especially regarding T1 disease.

Methods: Patients diagnosed with clinical (c) T1 ampullary cancer and patients with pathological (p) T1 in the case of cTx were included from the Netherlands Cancer Registry (2014-2021). Primary endpoint was OS, analyzed using the Kaplan-Meier estimator. Multivariable Cox proportional hazards regression was used to identify OS predictors.

Results: Overall, 244 patients with cT1 ampullary cancer were included, of whom 75% (n=184) underwent resection. Among these, 68% (n=125) were upstaged to a higher pathologically T classification (pT2:40%, pT3:22%, pT4:5%). Similarly, cN0 was upstaged to pN1 in 47% of patients (n=87). Next, 100 patients with pT1 and cTx ampullary cancer were included, making a total of 159 patients with pT1 tumor. 92% (146/159) underwent pancreatoduodenectomy while 8% (13/159) underwent endoscopic or local surgical resection. The 1- and 5-year OS for cT1N0 ampullary cancer were 72% and 36%, while for pT1N0 they were 94% and 75%. Independent poor prognostic factors for OS were pN1 classification (HR 2.12; 95%CI 1.15-3.94, P =0.017), pNx classification (i.e. locally resected patients) (HR 2.82; 95%CI 1.22-6.55, P =0.016), and poorly differentiated tumors (HR 4.05; 95%CI 1.33-12.40, P =0.014).

Conclusion: In patients with cT1 ampullary cancer, more than two-thirds had a pathologically higher T classification, and almost half had a pathologically higher N classification. These findings suggest that pancreatoduodenectomy is recommended for cT1 ampullary cancer.

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Conflict of interest statement

Conflicts of interest: J.d.V.G. has served as a consultant for Amgen, AstraZeneca, MSD, Pierre Fabre, and Servier, and has received institutional research funding from Servier. All outside the submitted work. S.M.E.G. reports institutional grants from Roche, Pfizer, Novartis, Eli Lilly, Daiichi Sankyo, Gilead and AstraZeneca. All outside the submitted work. M.J.B. has served as a consultant for Boston Scientific, Cook Medical, Pentax Medical and AMBU, and has received institutional funding from Boston Scientific, Cook Medical, Pentax Medical, Mylan, AMBU, and ChiRoStim, all outside the submitted work. I.H.J.T.d.H. received a research grant, paid to the institute from RanD Biotech for research not related to the submitted work. M.G.B. received research grants for investigator-initated trials from Intuitive Surgical, Medtronic, Oncosil, and Ethicon not related to the submitted work. The other authors have declared no conflicts of interest.

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