Original Article

Journal of Gastrointestinal Surgery

, Volume 15, Issue 8, pp 1411-1416

The Influence of Prognostic Factors and Adjuvant Chemoradiation on Survival After Pancreaticoduodenectomy for Ampullary Carcinoma

  • Timothy N. ShowalterAffiliated withDepartment of Radiation Oncology, Jefferson Medical College of Thomas Jefferson University, Kimmel Cancer Center
  • , Tingting ZhanAffiliated withDivision of Biostatistics, Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University
  • , P. Rani AnneAffiliated withDepartment of Radiation Oncology, Jefferson Medical College of Thomas Jefferson University, Kimmel Cancer Center
  • , Inna ChervonevaAffiliated withDivision of Biostatistics, Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University
  • , Edith P. MitchellAffiliated withDepartment of Medical Oncology, Jefferson Medical College of Thomas Jefferson University, Kimmel Cancer Center
  • , Charles J. YeoAffiliated withDepartment of Surgery, Jefferson Medical College of Thomas Jefferson University, and the Jefferson Pancreas, Biliary and Related Cancer Center
  • , Ernest L. RosatoAffiliated withDepartment of Surgery, Jefferson Medical College of Thomas Jefferson University, and the Jefferson Pancreas, Biliary and Related Cancer Center
  • , Eugene P. KennedyAffiliated withDepartment of Surgery, Jefferson Medical College of Thomas Jefferson University, and the Jefferson Pancreas, Biliary and Related Cancer Center
  • , Adam C. BergerAffiliated withDepartment of Surgery, Jefferson Medical College of Thomas Jefferson University, and the Jefferson Pancreas, Biliary and Related Cancer Center Email author 

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Abstract

Introduction

The prognosis after pancreaticoduodenectomy (PD) for ampullary carcinoma (AC) is superior to that of pancreatic cancer. Decisions regarding adjuvant therapy are influenced by factors such as nodal status, stage, and grade, but the influence of these individual variables on survival is unclear.

Methods

A prospective tumor registry database was queried to identify patients who underwent PD for AC at Thomas Jefferson University between Jan 1997 and Apr 2009. The study was conducted with the approval of the institutional review board. Data were collected through review of hospital and departmental charts. Overall survival (OS) was analyzed using univariate and multivariate Cox proportional hazard models. The proportional hazard assumption was verified for the overall model and individual covariates.

Results

A total of 61 patients underwent PD for AC at our institution. There were five perioperative deaths (8.2%). Mean age was 70 years (62% male). Median survival time (MST) was 50 months for all patients. Only primary tumor stage, T1/T2 versus T3/T4 (American Joint Committee on Cancer Staging, version 6), was associated with OS in univariate analyses (p = 0.003). The association of nodal status with OS was borderline-significant (p = 0.08), with the MST being 84 months for node-negative and 17 months for node-positive patients. The remaining covariates were not predictors of OS. In the multivariate analysis, only primary tumor stage (HR, 5.1; p < 0.001) and age (HR, 1.04; p = 0.06), but not nodal status or adjuvant therapy, were associated with overall survival.

Conclusions

Advanced primary tumor stage and age were associated with inferior OS after PD for AC. Adjuvant therapy did not impact survival. Patients with advanced tumor stage should be considered for clinical trials of adjuvant therapy after PD with novel compounds and optimized radiation therapy strategies.

Keywords

Ampullary cancer Adjuvant therapy Ampulla of Vater Adenocarcinoma