Clinicopathologic Analysis and Prognostic Factors for Survival in Patients with Operable Ampullary Carcinoma: A Multi-Institutional Retrospective Experience
Nebi Serkan Demirci,
Eyyup Cavdar,
Nuriye Yildirim Ozdemir,
Sinemis Yuksel,
Yakup Iriagac,
Gokmen Umut Erdem,
Hatice Odabas,
Ilhan Hacibekiroglu,
Mustafa Karaagac,
Mahmut Ucar,
Banu Ozturk,
Yakup Bozkaya
Affiliations
Nebi Serkan Demirci
Department of Medical Oncology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, 34098 Istanbul, Türkiye
Eyyup Cavdar
Department of Medical Oncology, Adiyaman Training and Research Hospital, Adiyaman University, 02000 Adiyaman, Türkiye
Nuriye Yildirim Ozdemir
Department of Medical Oncology, Faculty of Medicine, Yıldırım Beyazıt University, 06010 Ankara, Türkiye
Sinemis Yuksel
Department of Medical Oncology, Dr. Lutfi Kirdar Kartal Education and Research Hospital, 34865 Istanbul, Türkiye
Yakup Iriagac
Department of Medical Oncology, Balikesir Ataturk City Hospital, 10100 Balikesir, Türkiye
Gokmen Umut Erdem
Department of Medical Oncology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, 34098 Istanbul, Türkiye
Hatice Odabas
Department of Medical Oncology, Dr. Lutfi Kirdar Kartal Education and Research Hospital, 34865 Istanbul, Türkiye
Ilhan Hacibekiroglu
Department of Medical Oncology, Faculty of Medicine, Sakarya University, 54050 Sakarya, Türkiye
Mustafa Karaagac
Department of Medical Oncology, Meram Medical Faculty, Necmettin Erbakan University, 42090 Konya, Türkiye
Mahmut Ucar
Department of Medical Oncology, Faculty of Medicine, Erciyes University, 38039 Kayseri, Türkiye
Banu Ozturk
Department of Medical Oncology, Akdeniz University, 07058 Antalya, Türkiye
Yakup Bozkaya
Department of Medical Oncology, Yeniyuzyil University-Gaziosmanpasa Hospital, 34098 Istanbul, Türkiye
Background and Objectives: In ampullary cancer, 5-year survival rates are 30–50%, even with optimal resection and perioperative systemic therapies. We sought to determine the important clinicopathological features and adjuvant treatments in terms of the prognosis of patients with operable-stage ampullary carcinomas. Materials and Methods: We included 197 patients who underwent pancreaticoduodenectomy to treat ampullary carcinomas between December 2003 and May 2019. Demographics, clinical features, treatments, and outcomes/survival were analyzed. Results: The median disease-free survival (mDFS) and median overall survival (mOS) were 40.9 vs. 63.4 months, respectively. The mDFS was significantly lower in patients with lymphovascular invasion (p p = 0.027). Potential predictors of decreased OS on univariate analysis included age ≥ 50 years (p = 0.045), poor performance status (p = 0.048), weight loss (p = 0.045), T3–T4 tumors (p = 0.018), surgical margin positivity (p = 0.01), lymph node involvement (p = 0.001), lymphovascular invasion (p p = 0.007), and poor histological grade (p = 0.042). For the multivariate analysis, only nodal status (hazard ratio [HR]1.98; 95% confidence interval [CI], 1.08–3.65; p = 0.027) and surgical margin status (HR 2.61; 95% CI, 1.09–6.24; p = 0.03) were associated with OS. Conclusions: Nodal status and a positive surgical margin were independent predictors of a poor mOS for patients with ampullary carcinomas. Additional studies are required to explore the role of adjuvant therapy in patients with ampullary carcinomas.
