Adenocarcinoma of the Ampulla of Vater: T-Stage,Chromosome 17p Allelic Loss,and Extended Pancreaticoduodenectomy are Relevant Prognostic Factors |
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Authors: | Calogero Iacono Giuseppe Verlato Giuseppe Zamboni Aldo Scarpa Ettore Montresor Paola Capelli Luca Bortolasi Giovanni Serio |
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Institution: | (1) Department of Surgery and Gastroenterology, University of Verona Medical School, Verona, Italy;(2) Department of Medicine and Public Health, Unit of Epidemiology and Medical Statistics, University of Verona Medical School, Verona, Italy;(3) Department of Pathology, University of Verona Medical School, Verona, Italy;(4) Department of Surgery and Gastroenterology, University of Verona Medical School, University Hospital “GB Rossi”, Piazalle LA Scuro 10, 37134 Verona, Italy |
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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.
Presented at the 2006 Annual Meeting of the American Hepato-Pancreato-Biliary Association, Miami Beach, Florida, March 9–12,
2006 |
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Keywords: | Ampullary carcinoma Pancreaticoduodenectomy Extended pancreatic resection Microsatellite instability Chromosome 17p allelic losses |
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