Department of Surgery, Pancreatobiliary Cancer Clinic, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.
J Hepatobiliary Pancreat Sci. 2020 Oct;27(10):721-730. doi: 10.1002/jhbp.801. Epub 2020 Aug 15.
BACKGROUND/PURPOSE: Ampulla of Vater (AoV) carcinoma is a rare tumor that accounts for approximately 0.2% of gastrointestinal malignancies. There are no clinical guidelines concerning the treatment of AoV carcinoma. This study aimed to investigate the effectiveness of adjuvant treatment in AoV carcinoma following curative resection and define the "high-risk" group.
Clinical data of patients who underwent curative resection for AoV carcinoma in four hospitals, namely Yonsei Gangnam Severance Hospital, Seoul National University Hospital, Seoul National University Bundang Hospital, and National Cancer Center (n = 651; 2002-2015), were reviewed. Overall survival (OS) and recurrence-free survival (RFS) rates were compared using Kaplan-Meier estimates.
Data of 651 patients who had undergone curative resection were retrospectively reviewed. Age, T stage, N stage, and differentiation type remained strong and independent risk factors for RFS and OS. In early-stage AoV carcinoma (T1N0, T2N0), the non-adjuvant group had better prognosis based on the RFS and OS than the adjuvant group (P < .001, P = .007). In advanced T stage (T3N0, T4N0), the adjuvant group had better prognosis than the non-adjuvant group, but the difference was not statistically significant (P > .05). In node-positive patients (any T, N1/2), adjuvant treatment did not affect RFS and OS (P > .05).
Adjuvant treatment after curative resection of AoV carcinoma is not associated with improved survival. The high-risk group (node-positive or advanced T stage (T3, T4)) treated with adjuvant treatment was not statistically associated with improved survival; however, our study showed that the adjuvant treatment for the high-risk group might help achieve better patient outcome.
背景/目的：壶腹癌（Ampulla of Vater carcinoma）是一种罕见的肿瘤，约占胃肠道恶性肿瘤的 0.2%。目前尚无关于壶腹癌治疗的临床指南。本研究旨在探讨根治性切除术后辅助治疗壶腹癌的疗效，并确定“高危”人群。
回顾性分析在四家医院（延世大学江南Severance 医院、首尔国立大学医院、首尔国立大学盆唐医院和国家癌症中心）接受根治性切除术治疗壶腹癌的 651 例患者的临床资料（2002-2015 年）。采用 Kaplan-Meier 估计比较总生存（OS）和无复发生存（RFS）率。
回顾性分析了 651 例接受根治性切除术的患者的数据。年龄、T 分期、N 分期和分化类型仍然是 RFS 和 OS 的强烈且独立的危险因素。在早期壶腹癌（T1N0、T2N0）中，非辅助组的 RFS 和 OS 预后优于辅助组（P<0.001，P=0.007）。在晚期 T 分期（T3N0、T4N0）中，辅助组的预后优于非辅助组，但差异无统计学意义（P>0.05）。在淋巴结阳性患者（任何 T、N1/2）中，辅助治疗对 RFS 和 OS 没有影响（P>0.05）。
根治性切除术后辅助治疗壶腹癌并不能改善生存。高危组（淋巴结阳性或晚期 T 分期（T3、T4））接受辅助治疗与生存改善无统计学关联；然而，本研究表明，高危组的辅助治疗可能有助于改善患者的预后。
