Early recurrence following pancreaticoduodenectomy in patients with ampullary cancer

Abstract

Introduction: We aimed to identify the factors of patients with early recurrence (within 6months) following curative resection for ampullary cancer and to compare the immunohistochemical (IHC) expression rate of CK7, CK20, MUC1, MUC2, MUC5AC, MUC6, S100P and CDX2 between the two main histological subtypes of ampullary adenocarcinoma. Method: In this retrospective study, the postoperative outcomes and clinicopathologic factors for early recurrence that occurred in 14 of a total of 93 patients who underwent pancreaticoduodenectomy (PD) for ampullary adenocarcinoma between January 2002 and August 2014 were analyzed. Thereafter, we identified the factor that associated with early recurrence (within 6months) following surgery through the multivariate analyses. In addition, we compared the immunohistochemical (IHC) expression rate of CK7, CK20, MUC1, MUC2, MUC5AC, MUC6, S100P and CDX2 between the two main histological subtypes of ampullary adenocarcinoma. Result: The patients who underwent PD for ampullary cancer were divided into two groups: early recurrence and late recurrence. 14 patients (32.6%) showed the early recurrence and they showed the shorter median DFS and median OS than those of patients with late recurrence (DFS, 4.2 Vs. 49.7 months, p = 0.001; OS, 18.2 Vs. 113.7 months, p < 0.001). Large tumor, LN metastasis, and pancreatico-biliary type were independently associated with early recurrence in patients with ampullary cancer following PD. When we compared two histologic types of ampullary cancer through IHC staining, CK7, MUC1, and S100P were dominantly stained in pancreato-biliary type. In intestinal type, CK20 and CDX2 staining appeared more frequently and significantly. Conclusion: Ampullary cancer patients with large tumor, LN metastasis, and pancreatico-biliary type should be considered to have aggressive adjuvant treatment and follow-up more frequently postoperatively. In addition, different strategies of adjuvant therapy may be helpful to improve the outcomes of different histologic type tumors.