Narita Masato, Hatano Etsuro, Kitamura Koji, Fukumitsu Ken, Kitagawa Hirohisa, Hamaguchi Yuhei, Yazawa Takefumi, Terajima Hiroaki, Kitaguchi Kazuhiko, Hata Toshihiko
Department of Surgery National Hospital Organization Kyoto Medical Center Kyoto Japan.
Department of Surgery Kobe City Medical Center General Hospital Kobe Japan.
Ann Gastroenterol Surg. 2023 Dec 26;8(2):190-201. doi: 10.1002/ags3.12764. eCollection 2024 Mar.
Carcinoma of the ampulla of Vater (CAV) shows a favorable prognosis compared to that with the other periampullary tumors, while some cases have a poor prognosis. The aims of the present study are to clarify the clinicopathological factors associated with poor recurrence-free survival (RFS) in patients with CAV after curative resection and to validate the usefulness of adjuvant chemotherapy (AC).
The study design is a multicenter retrospective cohort study. Patients with CAV who underwent pancreaticoduodenectomy between January 2008 and December 2020 at 26 hospitals were analyzed. The 30 clinicopathological factors were evaluated. A propensity score matching (PSM) was used to compare between patients with and without AC.
Finally, 460 patients were analyzed. Median duration of follow-up was 47.2 months. Twenty-one prognostic factors associated with poor RFS were identified by univariate analysis. In multivariate analysis, aged ≥71, tumor diameter ≥12 mm, pT2 or higher stage (pT≥2), portal vein invasion (PV+), venous invasion(V+), and node positive disease (pN+) were independent prognostic factors for poor RFS. Out of 80 patients who received AC, 63 patients were assigned to analysis for PSM. The results showed no beneficial effect of AC on RFS. The preoperative factors potentially predicting pT≥2, V+, and/or N+ were at least one of following; (1) CA19-9 > 37 IU/mL, (2) ulcerative or mixed type appearance, (3) except for well-differentiated tumor, or (4) except for intestinal subtype of histology.
Aged ≥71, tumor diameter ≥12 mm, pT≥2, PV+, V+, and pN+ were independent prognostic factors for poor RFS in patients with CAV. An additional therapeutic strategy may be desirable in CAV patients at high risk for recurrence.
与其他壶腹周围肿瘤相比，壶腹癌（CAV）的预后较好，但部分病例预后较差。本研究的目的是明确根治性切除术后CAV患者无复发生存期（RFS）不佳的临床病理因素，并验证辅助化疗（AC）的有效性。
本研究设计为多中心回顾性队列研究。分析了2008年1月至2020年12月期间在26家医院接受胰十二指肠切除术的CAV患者。评估了30项临床病理因素。采用倾向评分匹配（PSM）法比较接受AC和未接受AC的患者。
最终分析了460例患者。中位随访时间为47.2个月。单因素分析确定了21个与RFS不佳相关的预后因素。多因素分析显示，年龄≥71岁、肿瘤直径≥12mm、pT2及以上分期（pT≥2）、门静脉侵犯（PV+）、静脉侵犯（V+）和淋巴结阳性疾病（pN+）是RFS不佳的独立预后因素。在80例接受AC的患者中，63例患者被纳入PSM分析。结果显示AC对RFS无有益影响。术前可能预测pT≥2、V+和/或N+的因素至少包括以下之一：（1）CA19-9>37IU/mL，（2）溃疡型或混合型外观，（3）除外高分化肿瘤，或（4）除外组织学肠型。
年龄≥71岁、肿瘤直径≥12mm、pT≥2、PV+、V+和pN+是CAV患者RFS不佳的独立预后因素。对于复发风险高的CAV患者，可能需要额外的治疗策略。
