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01-05-2007

Adenocarcinoma of the Ampulla of Vater: T-Stage, Chromosome 17p Allelic Loss, and Extended Pancreaticoduodenectomy are Relevant Prognostic Factors

Authors: Calogero Iacono, Giuseppe Verlato, Giuseppe Zamboni, Aldo Scarpa, Ettore Montresor, Paola Capelli, Luca Bortolasi, Giovanni Serio

Published in: Journal of Gastrointestinal Surgery | Issue 5/2007

Abstract

Objective

To evaluate the prognostic significance of different clinico-pathological and molecular factors, and to compare survival after standard and extended pancreaticoduodenectomy (PD) in ampulla of Vater adenocarcinoma (AVAC).

Summary Background Data

There are discordant data on factors affecting prognosis, and hence therapeutic choices, in AVAC.

Patients and Methods

Clinical-pathological factors were evaluated in 59 patients, subjected to PD for AVAC; in 42 subjects information on chromosome 17p and 18q allelic losses (LOH) and microsatellite instability (MSI) was also available. The association between survival and type of PD was investigated in the 25 patients operated between 1990 and 2001 (16 standard and nine extended).

Results

The overall 5- and 10-year tumor-related survival rates were 46% and 33%, respectively. Sixteen patients had T-stages 1–2, 14 T-stage 3, and 29 T-stage 4 cancers. Chromosome 17p and 18q LOH were detected in 23 (55%) and 15 cases (36%), respectively, and in 12 cases (29%) coexisted. Five cases were MSI-positive (12%). At univariate analysis, poor survival was associated with cancer ulceration (P = 0.051), poor differentiation (P = 0.008), T-stage 4 (P < 0.001), nodal metastases (P = 0.004), chromosome 17p (P < 0.001) and 18q LOH (P = 0.002), and absence of MSI (P = 0.009). At multivariate analysis, only T-stage (P = 0.002) and 17p LOH (P = 0.001) were independent predictors of survival. All patients with MSI-positive cancers were long-survivors (>12 yrs), whereas only 30% of MSI-negative cancer patients survived at 5 years. Extended pancreaticoduodenectomy was associated with a 3-year disease-related survival higher than standard resection (83% vs 31%; P = 0.018).

Conclusion

MSI and chromosome 17p status allow to better define prognosis within ampullary cancers at the same stage. Surgery alone resulted curative in MSI-positive cancer patients, whereas it was inadequate in patients showing allelic losses, who might benefit from adjuvant therapy. In this observational study, extended PD was associated with increased survival compared to standard procedures.

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Title: Adenocarcinoma of the Ampulla of Vater: T-Stage, Chromosome 17p Allelic Loss, and Extended Pancreaticoduodenectomy are Relevant Prognostic Factors
Authors: Calogero Iacono
Giuseppe Verlato
Giuseppe Zamboni
Aldo Scarpa
Ettore Montresor
Paola Capelli
Luca Bortolasi
Giovanni Serio
Publication date: 01-05-2007
Publisher: Springer-Verlag
Published in: Journal of Gastrointestinal Surgery / Issue 5/2007
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI: https://doi.org/10.1007/s11605-007-0136-9

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Adenocarcinoma of the Ampulla of Vater: T-Stage, Chromosome 17p Allelic Loss, and Extended Pancreaticoduodenectomy are Relevant Prognostic Factors

Abstract

Objective

Summary Background Data

Patients and Methods

Results

Conclusion

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Abstract

Objective

Summary Background Data

Patients and Methods

Results

Conclusion

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