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Ampullary neoplasms – how to treat in real-world practice? A retrospective study
Background
Ampullary carcinomas are rare malignant tumours, originating at the complex of the ampulla of Vater. Surgery is the only potentially curative treatment and prognosis has been related to lymph node involvement (N+), positive surgical margins (R1), and advanced tumor stages (pT3-4). Histopathological subtypes, such as pancreaticobiliary (PBH) and intestinal histotypes (IH) are prognostic factors to be validated. The benefit of adjuvant treatment is not consensual and prospective studies are needed.
Methods
Thus, this retrospective study aims to describe all localized ampullary tumours treated at our center between January 2015 and December 2020. SPSS was used for data analysis.
Results
Ninety-five patients included, with a median age of 68yrs (38-83), 54% male (n=51) and 60% stage III (n=57). Histopathological subtypes more frequently observed were PBH (n=42, 44%), followed by IH (n=32, 34%). Surgery was performed in all pts, with majority being pT3-T4 (n=51,54%), N+ (n=56,59%), with moderate differentiation (n=45, 47%) and R1 (n=13,14%). Forty-five pts (47%) underwent adjuvant chemotherapy. Relapse was observed in 21% of pts (n=20), half of which after adjuvant treatment. Adjuvant treatment more commonly used was gemcitabine (n=9), gemcitabine/capecitabine (n=4) and chemoradiotherapy(n=4). A total of 16 deaths registered. Median disease-free survival since surgery (PFS) was of 10 months (5.7 – 12.4) and median overall survival (OS) of 21 months (10.9 – 31.1). In IH, elevated baseline CA 19.9 (>37.5U/L) was associated with lower PFS (p=0.046). In PBH, a better OS registered in pts who did adjuvant chemotherapy (p=0.028).
Conclusions
Heterogeneous and small sized samples are limitations in real-world clinical practice. Elevated tumour markers and histopathological subtypes can be considered in treatment decisions. Prospective studies are warranted.
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosures
All authors have declared no conflicts of interest.
