Clinical characteristics, treatment, and oncological outcomes in patients with ampullary cancer at a reference center in Mexico.

Abstract

617 Background: Ampullary cancer (AC) represents 0.2% of gastrointestinal cancers. Given the rarity of the disease, information regarding treatment strategies and outcomes derives from studies that include the different types of periampullary cancers, which constitute a heterogeneous group. Our aim was to describe the clinical characteristics, treatment modalities and outcomes in patients (pts) with true AC treated at our institution. Methods: A retrospective review of medical records of all consecutive pts with histological diagnosis of AC evaluated at our institution from Jan 2009-Dec 2019. Clinical, pathological and laboratory variables at diagnosis were recorded. Overall survival (OS) was estimated by Kaplan-Meier and compared with the Log-rank test. Statistical significance was determined at P<0.05. Results: 133 pts with AC were included. Median age was 62 yo (IQR 53-70), 51.9% were women. 25% had ampullary adenoma history. Symptoms at diagnosis: 89% jaundice, 63% weight loss and 56% abdominal pain. Median laboratory values were total bilirubin 1.7 mg/dL (0.7-5.1), albumin 3.7 g/dL (3.1-4.2), hemoglobin 12.6 g/dL (10.9-14.2), carbohydrate antigen (CA) 19-9 34.7 U/mL (6.4-113.9) and carcinoembryonic antigen (CEA) 2.6 ng/mL (1.2-4.2). Most tumors were moderately differentiated (59%). Histologic subtypes of adenocarcinoma were available in 84 pts: intestinal 46.4%, pancreaticobiliary 39.3% and mixed 14.3%. Stage at diagnosis was localized (46%), locally advanced N+ (29%) and advanced (25%). For those with localized/locally advanced disease, 91% (91/100) underwent surgical resection, 25.3% (23/91) received adjuvant chemotherapy (ChT), 69.6% (16/23) received single agent and 30.4% (7/23) duplet. Pts who received adjuvant Cht presented N+ in 69.6%, moderate differentiation in 73.9%, intestinal 47.8% and pancreaticobiliary subtype 43.5%. In advanced setting, 63.6% (21/33) received palliative Cht, 66.7% received a duplet regimen. Median OS was 32.8 (22.9-42.8) months (mos). Median OS according to stage was 152.1, 28.1 and 10.2 mos for localized, locally advanced, and advanced, respectively (P<0.001). OS univariate analysis is shown in table. Conclusions: Most of pts presented with localized/locally advanced disease, were eligible to surgical resection and had a better survival. For those with N+ disease it is required to evaluate the role of adjuvant Cht. In the advanced setting, Cht improves prognosis.[Table: see text]