Duhn Jannis, Strässer Julia, von Fritsch Lennart, Braun Rüdiger, Honselmann Kim C, Kist Markus, Abdalla Thaer S A, Kleihues-van Tol Kees, Franke Bianca, Reinwald Fabian, Sackmann Andrea, Holleczek Bernd, Krauß Anna, Klinkhammer-Schalke Monika, Zeissig Sylke R, Deichmann Steffen, Keck Tobias, Wellner Ulrich F, Bolm Louisa
Department of Surgery, University Medical Center Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23562 Lübeck, Germany.
Network for Care, Quality and Research in Oncology, German Cancer Registry Group of the Association of German Tumor Centers (ADT), 14057 Berlin, Germany.
J Clin Med. 2025 May 30;14(11):3869. doi: 10.3390/jcm14113869.
: Ampullary adenocarcinomas (AMPACs) represent rare malignant neoplasms arising in the Ampulla of Vater. Due to a lack of prospective studies and heterogeneous results from retrospective analyses, the outcomes of adjuvant chemotherapy (AC) in AMPAC are unclear. : Pooled, pseudonymized data were retrieved from clinical cancer registries participating in the German Cancer Registry Group of the Association of German Tumor Centers (GCRG/ADT). Patients who underwent surgical resection of AMPACs (ICD-10: C24.1) with subsequent follow-up or AC were included. Patients with 90-day postoperative mortality were excluded. The epidemiologic and histopathologic features as well as the overall survival and recurrences were compared in both groups using R statistics. : In total, 830 patients with AMPACs were identified, of which 184 (22.2%) received AC. The surgery + AC patients showed more advanced tumor stages and more pronounced locoregional invasion as compared to the group undergoing surgery alone. AC was independently associated with an improved overall survival (OS) in a multivariable analysis (HR 0.57, < 0.001), where pT3-4 status, lymph node metastases, vascular invasion, and advanced grading remained independent prognostic factors for OS. In the subgroup analyses, AC was associated with improved OS in the patients with pT3-4 tumors, lymph node metastases, lymphovascular invasion, and advanced grading, or UICC stage III, whereas no association with the OS was observed in the other subgroups. AC was also associated with superior disease-free survival (DFS) in a multivariable analysis. : We provide a large-scale population-based analysis of AMPAC patients, showing an association of AC with improved OS in patients with advanced-staged disease or signs of locoregional invasion as compared to surgery alone.
壶腹腺癌（AMPACs）是发生于 Vater 壶腹的罕见恶性肿瘤。由于缺乏前瞻性研究且回顾性分析结果存在异质性，AMPAC 辅助化疗（AC）的疗效尚不清楚。从参与德国肿瘤中心协会德国癌症登记组（GCRG/ADT）的临床癌症登记处检索汇总的、匿名化数据。纳入接受 AMPACs 手术切除（国际疾病分类第十版：C24.1）并随后进行随访或 AC 的患者。排除术后 90 天内死亡的患者。使用 R 统计量对两组的流行病学和组织病理学特征以及总生存期和复发情况进行比较。总共识别出 830 例 AMPACs 患者，其中 184 例（22.2%）接受了 AC。与单纯手术组相比，手术 + AC 组患者的肿瘤分期更晚，局部区域侵犯更明显。在多变量分析中，AC 与总生存期（OS）改善独立相关（风险比 0.57，<0.001），其中 pT3 - 4 状态、淋巴结转移、血管侵犯和高级别分级仍然是 OS 的独立预后因素。在亚组分析中，AC 与 pT3 - 4 肿瘤、淋巴结转移、淋巴管侵犯和高级别分级或 UICC Ⅲ期患者的 OS 改善相关，而在其他亚组中未观察到与 OS 的关联。在多变量分析中，AC 也与无病生存期（DFS）改善相关。我们对 AMPAC 患者进行了大规模的基于人群的分析，结果显示与单纯手术相比，AC 与晚期疾病或局部区域侵犯迹象患者的 OS 改善相关。
