Abstract
BackgroundAmpulla of Vater cancer (AoV Ca) is a rare tumor, and its adjuvant treatment has not been established. The purpose of this study was to find out prognostic factors including host immunity and role of adjuvant treatment in AoV Ca.Methods and FindingsWe reviewed 227 AoV Ca patients with curative resection. Clinical characteristics, adjuvant treatment, disease-free survival (DFS) and overall survival (OS) were analyzed. Among all patients, 63.9, 36.1 and 33.9% had T1/T2, T3/T4 stage and lymph node-positive disease (LN+), respectively. OS of all patients was 90.9 months (95% CI: 52.9–129.0). OS was different according to neutrophil-to-lymphocyte ratio (HR 1.651, 95% CI: 1.11–2.47), platelet-to-lymphocyte ratio (HR 1.488, 95% CI: 1.00–2.21) and systemic inflammatory index (HR 1.669, 95% CI: 1.13–2.47). In multivariate analysis, adverse prognostic factors for OS included vascular invasion (HR 2.571, 95% CI: 1.20–5.53) and elevated CA 19–9 (HR 1.794, 95% CI: 1.07–3.05). A total of 104 patients (46.3%) received adjuvant treatment (25 out of 111of T1/T2 & LN (-), 79 out of 116 of T3/T4 or LN (+)). In T3/T4 or LN (+) stage, adjuvant CCRT with maintenance chemotherapy provided the longest OS (5-year OS rate: 47.0 vs. 41.4%).ConclusionsVascular invasion and elevated CA 19–9 were adverse prognostic factors in resected AoV Ca. In T3/T4 or LN (+) stage, adjuvant CCRT with maintenance chemotherapy provided the best survival outcome. Adjuvant treatment should be further defined in AoV Ca, especially with poor prognostic factors.
Highlights
The annual incidence of biliary tract cancer (BTC) in the Western world is about 5–6 per 100,000, while the annual incidence in Korea is 10 per 100,000.[1, 2] BTC has a worse prognosis than other malignancies.[2]
overall survival (OS) was different according to neutrophil-to-lymphocyte ratio (HR 1.651, 95% CI: 1.11–2.47), platelet-tolymphocyte ratio (HR 1.488, 95% CI: 1.00–2.21) and systemic inflammatory index (HR 1.669, 95% CI: 1.13–2.47)
Adjuvant treatment should be further defined in Ampulla of Vater cancer (AoV Ca), especially with poor prognostic factors
Summary
The annual incidence of biliary tract cancer (BTC) in the Western world is about 5–6 per 100,000, while the annual incidence in Korea is 10 per 100,000.[1, 2] BTC has a worse prognosis than other malignancies.[2]. Ampulla of Vater cancer (AoV Ca) accounts for 10–15% of BTC in Korea, which arises from distal to the confluence of the common bile duct with the main pancreatic duct.[10] Initial presentations of AoV Ca are usually related to biliary obstruction such as jaundice, red urine and pruritus, potentially resulting in early detection.[11] Approximately 80% of AoV Ca patients were detected at a potentially resectable stage at the time of diagnosis. The role of adjuvant treatment should be accurately defined in patients with poor prognosis. Ampulla of Vater cancer (AoV Ca) is a rare tumor, and its adjuvant treatment has not been established.
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