Roth G, Pellat A, Piessen G, le Malicot K, Schwarz L, Gallois C, Tougeron D, Hautefeuille V, Jary M, Benoist S, Amil M, Desgrippes R, Muller M, Lecomte T, Guillet M, Locher C, Genet C, Manfredi S, Bouché O, Taieb J
University Grenoble Alpes/Hepato-Gastroenterology and Digestive Oncology Department, CHU Grenoble Alpes/Institute for Advanced Biosciences, CNRS UMR 5309-INSERM U1209, Grenoble, France.
Service de gastroentérologie, d'endoscopie et d'oncologie digestive, Hôpital Cochin, APHP, Paris, France; Centre of Research in Epidemiology and Statistics (CRESS), Université Paris Cité, INSERM U1153, Paris, France.
ESMO Open. 2024 Dec;9(12):103988. doi: 10.1016/j.esmoop.2024.103988. Epub 2024 Nov 18.
Ampullary carcinoma (AC) is a rare and severe gastrointestinal cancer with a disease recurrence rate of around 40% after curative-intent surgery and for which the main prognostic factors and adjuvant treatment decision remain a matter of debate.
The FFCD-AC cohort is a French nationwide prospective cohort, which included patients with non-metastatic resected AC. The primary objective of this study was to describe prognostic factors associated with disease-free survival (DFS) and overall survival (OS) after pancreaticoduodenectomy (PD) so as to propose a user-friendly score to better estimate the risk of recurrence. The secondary objective was to study the benefit of adjuvant therapy in terms of DFS and OS.
Three hundred and seventy patients with resected AC were included. Median follow-up was 40.6 months. Median age was 68.5 years (32.0-87.0 years), 53.8% of patients were male and 56.1%/37.4%/6.5% had an Eastern Cooperative Oncology Group performance status 0/1/2, respectively. Pathological subtype was intestinal/pancreatobiliary/mixed-undetermined in 29.5%/40.5%/30.0% of patients, respectively. Adjuvant chemotherapy was carried out in 61% of patients. In multivariable analysis, stage III tumor [hazard ratio (HR) 2.86, (95% confidence interval {95% CI}: 1.89-4.17), P < 0.0001], high tumor grade [HR 2.51, (95% CI: 1.42-4.43), P = 0.002] and non-intestinal subtype [HR 1.58, (95% CI: 1.00-2.49), P = 0.052] were associated with shorter DFS. A score based on these three parameters divided patients into low (n = 83), intermediate (n = 133) and high risk (n = 96) with median DFS not reached (NR)/73.1/15.2 months and a median OS NR/86.1/38.2 months, respectively. After propensity score matching, adjuvant chemotherapy was associated with longer DFS [HR 0.57, (95% CI: 0.45-0.72), P < 0.0001] in the cohort.
Our integrated score based on three easy-to-collect items-lymph node invasion, tumor grade and non-intestinal subtypes-seems highly prognostic in resected AC and needs to be confirmed in an external validation dataset to help adjuvant treatment decision making.
壶腹癌（AC）是一种罕见且严重的胃肠道癌症，根治性手术后疾病复发率约为40%，其主要预后因素和辅助治疗决策仍存在争议。
FFCD-AC队列是一项法国全国性前瞻性队列研究，纳入了非转移性切除性AC患者。本研究的主要目的是描述胰十二指肠切除术（PD）后与无病生存期（DFS）和总生存期（OS）相关的预后因素，从而提出一个便于使用的评分系统以更好地评估复发风险。次要目的是研究辅助治疗在DFS和OS方面的获益。
纳入了370例接受切除性AC治疗的患者。中位随访时间为40.6个月。中位年龄为68.5岁（32.0 - 87.0岁），53.8%的患者为男性，分别有56.1%/37.4%/6.5%的患者东部肿瘤协作组体能状态为0/1/2。病理亚型分别为肠型/胰胆管型/混合型-未确定的患者占29.5%/40.5%/30.0%。61%的患者接受了辅助化疗。在多变量分析中，III期肿瘤[风险比（HR）2.86，（95%置信区间{95%CI}：1.89 - 4.17），P < 0.0001]、高肿瘤分级[HR 2.51，（95%CI：1.42 - 4.43），P = 0.002]和非肠型亚型[HR 1.58，（95%CI：1.00 - 2.49），P = 0.052]与较短的DFS相关。基于这三个参数的评分系统将患者分为低风险（n = 83）、中风险（n = 133）和高风险（n = 96）组，DFS的中位数未达到（NR）/73.1/15.2个月，OS的中位数分别为NR/86.1/38.2个月。在倾向评分匹配后，辅助化疗与队列中更长的DFS相关[HR 0.57，（95%CI：0.45 - 0.72），P < 0.0001]。
我们基于淋巴结侵犯、肿瘤分级和非肠型亚型这三个易于收集的指标构建的综合评分系统，在切除性AC中似乎具有高度预后价值，需要在外部验证数据集中进行确认，以帮助辅助治疗决策。
