Materiały źródłowe

• #1 The pathohistological subtype strongly predicts survival in patients with ampullary carcinoma | Scientific Reports

  https://www.nature.com/articles/s41598-019-49179-w

  Ampullary cancer represents approximately 6% of the malignant periampullary tumors. An early occurrence of symptoms leads to a 5-year survival rate after curative surgery of 30 to 67%. […] In addition to the tumor stage, the immunohistological subtypes appear to be important for postoperative prognosis. […] Survival analysis showed a significantly worse 5-year survival rate for the pancreatobiliary subtype compared with the intestinal subtype (27.5% versus 61%, p0.001). […] The pathohistological subtypes of ampullary cancer allows a prediction of the postoperative prognosis. […] The pancreatobiliary subtype is significantly associated with a generally higher tumor stage at the time of presentation compared with the other subtypes. […] The survival analysis of the different subtypes was calculated using the Kaplan-Meier method with log rank test.

• #2 Ampullary Carcinoma: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/276413-overview

  Survival after surgical resection is related to the extent of local invasion of the primary lesion, lymph node involvement, vascular invasion, perineural invasion, cellular differentiation, and uninvolved surgical margins. Even a single lymph node with evidence of metastatic carcinoma portends a poor outcome with surgery alone. […] Patients with ampullary tumors have an overall better prognosis than those with pancreatic cancer and studies have demonstrated better survival after surgical resection for ampullary cancer. Ampullary tumors are more likely to result in biliary obstruction earlier in their course, and therefore tend to present at an earlier stage compared to most pancreatic cancers. […] A systematic review of 71 studies (8,280 patients) by Zhou et al noted a median 5-year overall survival rate of 58% and disease-free survival rate of 51%.

• #3 Prognostic Factors for Long-Term Survival in Patients with Ampullary Carcinoma: The Results of a 15-Year Observation Period after Pancreaticoduodenectomy

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3958923/

  The overall 1-, 5-, 10-, and 15-year survival rates were 79%, 40%, 24%, and 10%, respectively. […] Survival analysis showed that positive lymph node involvement (P = 0.001), lymphatic vessel invasion (P = 0.0001), intraoperative administration of packed red blood cells (P = 0.03), an elevated CA 19-9 (P = 0.03), jaundice (P = 0.04), and an impaired patient condition (P = 0.01) are strong negative predictors for a reduced patient survival. […] Long-term survival depends strongly on lymphatic nodal and vessel involvement. Moreover, a preoperative elevated CA 19-9 proved to be a significant prognostic factor. […] After 1-, 5-, 10-, and 15-year periods, the overall survival of the examined patient population was 79%, 40%, 25%, and 10%, respectively, with a median survival term of 37 months.

• #4 Ampullary Carcinoma: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/276413-overview

  Survival after surgical resection is related to the extent of local invasion of the primary lesion, lymph node involvement, vascular invasion, perineural invasion, cellular differentiation, and uninvolved surgical margins. Even a single lymph node with evidence of metastatic carcinoma portends a poor outcome with surgery alone. […] Patients with ampullary tumors have an overall better prognosis than those with pancreatic cancer and studies have demonstrated better survival after surgical resection for ampullary cancer. Ampullary tumors are more likely to result in biliary obstruction earlier in their course, and therefore tend to present at an earlier stage compared to most pancreatic cancers. […] A systematic review of 71 studies (8,280 patients) by Zhou et al noted a median 5-year overall survival rate of 58% and disease-free survival rate of 51%.

• #5 Prognostic Factors for Long-Term Survival in Patients with Ampullary Carcinoma: The Results of a 15-Year Observation Period after Pancreaticoduodenectomy

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3958923/

  The overall 1-, 5-, 10-, and 15-year survival rates were 79%, 40%, 24%, and 10%, respectively. […] Survival analysis showed that positive lymph node involvement (P = 0.001), lymphatic vessel invasion (P = 0.0001), intraoperative administration of packed red blood cells (P = 0.03), an elevated CA 19-9 (P = 0.03), jaundice (P = 0.04), and an impaired patient condition (P = 0.01) are strong negative predictors for a reduced patient survival. […] Long-term survival depends strongly on lymphatic nodal and vessel involvement. Moreover, a preoperative elevated CA 19-9 proved to be a significant prognostic factor. […] After 1-, 5-, 10-, and 15-year periods, the overall survival of the examined patient population was 79%, 40%, 25%, and 10%, respectively, with a median survival term of 37 months.

• #6 The role of lymph nodes in predicting the prognosis of ampullary carcinoma after curative resection | World Journal of Surgical Oncology | Full Text

  https://wjso.biomedcentral.com/articles/10.1186/s12957-015-0643-1

  Lymph node involvement is one of the well-demonstrated prognostic factors in ampullary carcinoma. The aim of this study is to clarify the role of lymph nodes in predicting the survival outcome of ampullary carcinoma. […] Concerning the node-associated variables, positive nodal status, positive lymph node number 2, THLN number 14, and LNR 0.15 were significantly associated with poorer survival outcomes, with a 5-year survival rate of 20.3, 38.9, 25.4, and 18 %, respectively. By multivariate analysis, nodal status and THLN number were two independent predictors of survival. […] Tumor biology reflected by lymph node status is the most important independent prognostic factor; nevertheless, surgical radicality based on THLN number also plays a significant role in the survival outcome for patients with ampullary carcinoma after curative pancreaticoduodenectomy.

• #7 The role of lymph nodes in predicting the prognosis of ampullary carcinoma after curative resection | World Journal of Surgical Oncology | Full Text

  https://wjso.biomedcentral.com/articles/10.1186/s12957-015-0643-1

  Lymph node involvement is one of the well-demonstrated prognostic factors in ampullary carcinoma. The aim of this study is to clarify the role of lymph nodes in predicting the survival outcome of ampullary carcinoma. […] Concerning the node-associated variables, positive nodal status, positive lymph node number 2, THLN number 14, and LNR 0.15 were significantly associated with poorer survival outcomes, with a 5-year survival rate of 20.3, 38.9, 25.4, and 18 %, respectively. By multivariate analysis, nodal status and THLN number were two independent predictors of survival. […] Tumor biology reflected by lymph node status is the most important independent prognostic factor; nevertheless, surgical radicality based on THLN number also plays a significant role in the survival outcome for patients with ampullary carcinoma after curative pancreaticoduodenectomy.

• #8 The role of lymph nodes in predicting the prognosis of ampullary carcinoma after curative resection | World Journal of Surgical Oncology | Full Text

  https://wjso.biomedcentral.com/articles/10.1186/s12957-015-0643-1

  The best survival outcome was seen in patients with negative nodal status and THLN 14 with a favorable 5-year survival rate of 84.4 %, which was much better than that of patients in other categories. […] Lymph node involvement might imply that the tumor behavior changes on its way from confinement in origin organ toward distant metastasis. […] In our study cohort, patients with positive lymph node status had significant higher stage, larger tumor size, higher grade of cell differentiation, presence of perineural invasion, and lymphovascular invasion (all P0.05, Table 3). All these findings indicated that tumors in patients with positive nodal status have the tendency toward poorer prognosis. […] Since THLN number and nodal status were both independent prognostic factors of ampullary carcinoma, as expected, patient with THLN number 14 and negative nodal status had the most favorable survival outcome in this study. In contrast, patients with THLN number 14 and positive nodal status had poorest survival outcome. […] Lymph node status which could indicate tumor biology is the most powerful independent prognostic factor for patients with ampullary carcinoma undergoing curative resection. Nevertheless, THLN number is also an independent prognostic factor.

• #9 The pathohistological subtype strongly predicts survival in patients with ampullary carcinoma | Scientific Reports

  https://www.nature.com/articles/s41598-019-49179-w

  Ampullary cancer represents approximately 6% of the malignant periampullary tumors. An early occurrence of symptoms leads to a 5-year survival rate after curative surgery of 30 to 67%. […] In addition to the tumor stage, the immunohistological subtypes appear to be important for postoperative prognosis. […] Survival analysis showed a significantly worse 5-year survival rate for the pancreatobiliary subtype compared with the intestinal subtype (27.5% versus 61%, p0.001). […] The pathohistological subtypes of ampullary cancer allows a prediction of the postoperative prognosis. […] The pancreatobiliary subtype is significantly associated with a generally higher tumor stage at the time of presentation compared with the other subtypes. […] The survival analysis of the different subtypes was calculated using the Kaplan-Meier method with log rank test.

• #10 The pathohistological subtype strongly predicts survival in patients with ampullary carcinoma | Scientific Reports

  https://www.nature.com/articles/s41598-019-49179-w

  The mean survival time for the pancreatobiliary subtype was 52 months, for the intestinal subtype 115 months, and for the mixed subtype 94 months (p=0.001). […] Therefore, the pancreatobiliary subtype shows a significantly poorer overall survival. […] A significantly worse 5-year survival rate was found for the pancreatobiliary subtype with 27.5% compared with the intestinal subtype with 61% (p=0.001). […] The subtype was also found to be an independent survival-predicting risk factor (HR: 0.45, p=0.022) in our study. […] The poorer prognosis of the pancreatobiliary subtype could probably be explained by a disseminating growth behavior, perineural sheet invasion, and by a distinct desmoplastic stromal reaction. […] The better prognosis of the intestinal subtype could be explained by its precursor lesions, which arise from preexisting adenomas following the adenoma-dysplasia-adenocarcinoma sequence. […] The pancreatobiliary subtype is associated with poor prognosis and a higher rate of lymph node metastasis, whereas the intestinal subtype shows an excellent prognosis.

• #11 The pathohistological subtype strongly predicts survival in patients with ampullary carcinoma | Scientific Reports

  https://www.nature.com/articles/s41598-019-49179-w

  The mean survival time for the pancreatobiliary subtype was 52 months, for the intestinal subtype 115 months, and for the mixed subtype 94 months (p=0.001). […] Therefore, the pancreatobiliary subtype shows a significantly poorer overall survival. […] A significantly worse 5-year survival rate was found for the pancreatobiliary subtype with 27.5% compared with the intestinal subtype with 61% (p=0.001). […] The subtype was also found to be an independent survival-predicting risk factor (HR: 0.45, p=0.022) in our study. […] The poorer prognosis of the pancreatobiliary subtype could probably be explained by a disseminating growth behavior, perineural sheet invasion, and by a distinct desmoplastic stromal reaction. […] The better prognosis of the intestinal subtype could be explained by its precursor lesions, which arise from preexisting adenomas following the adenoma-dysplasia-adenocarcinoma sequence. […] The pancreatobiliary subtype is associated with poor prognosis and a higher rate of lymph node metastasis, whereas the intestinal subtype shows an excellent prognosis.

• #12 The Optimal Cutoff Value of Tumor Markers for Prognosis Prediction in Ampullary Cancer

  https://www.mdpi.com/2072-6694/15/8/2281

  The optimal cutoff value for CA 19-9 was found to be 46 U/mL. This new cutoff value was a statistically significant prognostic factor for AC and may be used to evaluate the prognosis of AC and determine treatment strategies such as surgical treatments and adjuvant chemotherapy. […] The new cutoff value of CA 19-9 46 U/mL may be used for evaluating the prognosis of AC. Therefore, it may be an effective indicator for determining treatment strategies such as surgical treatments and adjuvant chemotherapy. […] The prognostic factors for AC were CA 19-9, histologic grade, N stage, and history of adjuvant chemotherapy, and as a tumor marker cutoff value, the CA 19-9 level 46 U/mL rather than 36 U/mL showed statistically significant results. Therefore, tumor markers can be used as important reference data when deciding treatment policies for patients with AC.

• #13 The Optimal Cutoff Value of Tumor Markers for Prognosis Prediction in Ampullary Cancer

  https://www.mdpi.com/2072-6694/15/8/2281?type=check_update&version=1

  The optimal cutoff value for CA 19-9, 46 U/mL was derived using the C-tree method. […] The new cutoff value of CA 19-9 46 U/mL may be used for evaluating the prognosis of AC. Therefore, it may be an effective indicator for determining treatment strategies such as surgical treatments and adjuvant chemotherapy. […] The prognostic factors for AC were CA 19-9, histologic grade, N stage, and history of adjuvant chemotherapy, and as a tumor marker cutoff value, the CA 19-9 level 46 U/mL rather than 36 U/mL showed statistically significant results. Therefore, tumor markers can be used as important reference data when deciding treatment policies for patients with AC.

• #14 CAU Scholar’s Space: The Optimal Cutoff Value of Tumor Markers for Prognosis Prediction in Ampullary Cancer

  https://scholarworks.bwise.kr/cau/handle/2019.sw.cau/78885

  The Optimal Cutoff Value of Tumor Markers for Prognosis Prediction in Ampullary Canceropen access […] This study aimed to determine the relationship between the prognosis of ampullary cancer (AC) and the level of the tumor marker CA 19-9 (carbohydrate antigen 19-9), and to identify the optimal cutoff values for CA 19-9. […] This new cutoff value was a statistically significant prognostic factor for AC and may be used to evaluate the prognosis of AC and determine treatment strategies such as surgical treatments and adjuvant chemotherapy. […] The new cutoff value of CA 19-9 46 U/mL may be used for evaluating the prognosis of AC. Therefore, it may be an effective indicator for determining treatment strategies such as surgical treatments and adjuvant chemotherapy.

• #15 The Optimal Cutoff Value of Tumor Markers for Prognosis Prediction in Ampullary Cancer

  https://www.mdpi.com/2072-6694/15/8/2281

  The optimal cutoff value for CA 19-9 was found to be 46 U/mL. This new cutoff value was a statistically significant prognostic factor for AC and may be used to evaluate the prognosis of AC and determine treatment strategies such as surgical treatments and adjuvant chemotherapy. […] The new cutoff value of CA 19-9 46 U/mL may be used for evaluating the prognosis of AC. Therefore, it may be an effective indicator for determining treatment strategies such as surgical treatments and adjuvant chemotherapy. […] The prognostic factors for AC were CA 19-9, histologic grade, N stage, and history of adjuvant chemotherapy, and as a tumor marker cutoff value, the CA 19-9 level 46 U/mL rather than 36 U/mL showed statistically significant results. Therefore, tumor markers can be used as important reference data when deciding treatment policies for patients with AC.

• #16 Prognostic Factors for Long-Term Survival in Patients with Ampullary Carcinoma: The Results of a 15-Year Observation Period after Pancreaticoduodenectomy

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3958923/

  In the multivariate analysis lymphatic vessel invasion, intraoperative administration of PRBCs, and an elevated CA 19-9 level were identified as independent risk factors for a reduced long-term survival. […] The prognosis of ampullary carcinoma is clearly better than that of other carcinomas of the periampullary region. Nevertheless, the results of our study show that factors such as an increased tumor stage, considerable invasion depth of the tumor, positive lymph node involvement, blood vessel and lymphatic invasion of the tumor, and a CA 19-9 level higher than 37U/L are accompanied by a reduced long-term prognosis. Subsequent adjuvant therapy remains essential especially in patients with this constellation of risk factors.

• #17 The Clinical Benefit of Adjuvant Therapy in Long-Term Survival of Early-Stage Ampullary Carcinoma: A Single Institutional Experience | Manne | Journal of Clinical Medicine Research

  https://www.jocmr.org/index.php/JOCMR/article/view/4267/25893229

  The median OS and progression-free survival (PFS) for all the patients who had definitive surgery were 40.5 months and 28 months, respectively. […] In the early-stage AC with no high-risk features, adjuvant therapy did not improve the survival over surgery alone (40.5 vs. 51.7 months, P = 0.93). […] In the early-stage AC, adjuvant therapy may not improve the outcome in the short term but may benefit over a long period. […] The addition of radiation to CT did not yield improved outcome in early-stage cancers. […] The univariate analysis showed a statistically significant influence of pathological staging (P stage) 2, LN metastasis, PNE, and PPE on the OS and PFS. […] In the early-stage AC group, the median OS and PFS were 44.1 months and 40.5 months, respectively. […] There was no significant difference in the median OS for the patients who were on surveillance compared to those who received adjuvant therapy (40.5 vs. 51.7 months, P = 0.93).

• #18 Ampullary Carcinoma: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/276413-overview

  Allema et al reported a 5-year overall survival rate of 50% in patients who underwent resection (subtotal or total pancreaticoduodenectomy) for ampullary cancer. Additionally, this series demonstrated that involvement of resection margins was the strongest prognostic factor for overall survival: patients with negative margins at resection had 5-year survival rates of up to 60%, compared with 15% in patients with positive margins (P 0.001). […] Unfortunately, most patients with carcinoma of the ampulla of Vater die of recurrent disease. Treatment fails in nearly 70% of patients with poor prognostic features, and these patients ultimately die of their disease.

• #19 Prognostic Factors and Survival of Patients with Carcinoma of the Ampulla of Vater after Pancreaticoduodenectomy

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5563104/

  Although carcinoma of the ampulla of Vater (CAV) is a rare tumor, accounting for just 0.2% of gastrointestinal cancers, the survival of CAV patients is unfavorable. The five-year rates have ranged from 36.8-75.2% in previous reports but there is a lack of data relating to Thai people. […] The findings of the study indicate that the overall survival of CAV patients after surgery is quite fair, with a tendency for better outcome with early as compared to advanced lesions. The key prognostic factors were recurrence, moderate and poor differentiation, comorbidity and tumor size 2.0 cm. […] The overall 5 year survival rate of CAV patients was 33.3 months. Although overall median survival time was 75.3 months. The trend was that the early stages (stage IA, IB and IIA) had a higher median survival time than the advanced stages (stage IIB and III) (78.9 vs. 30.3 months, p = 0.066). […] The key prognostic factors were recurrence, moderate and poor differentiation, comorbidity and tumor size 2.0 cm.

• #20 Prognostic Factors for Long-Term Survival in Patients with Ampullary Carcinoma: The Results of a 15-Year Observation Period after Pancreaticoduodenectomy

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3958923/

  The overall 1-, 5-, 10-, and 15-year survival rates were 79%, 40%, 24%, and 10%, respectively. […] Survival analysis showed that positive lymph node involvement (P = 0.001), lymphatic vessel invasion (P = 0.0001), intraoperative administration of packed red blood cells (P = 0.03), an elevated CA 19-9 (P = 0.03), jaundice (P = 0.04), and an impaired patient condition (P = 0.01) are strong negative predictors for a reduced patient survival. […] Long-term survival depends strongly on lymphatic nodal and vessel involvement. Moreover, a preoperative elevated CA 19-9 proved to be a significant prognostic factor. […] After 1-, 5-, 10-, and 15-year periods, the overall survival of the examined patient population was 79%, 40%, 25%, and 10%, respectively, with a median survival term of 37 months.

• #21 Prognostic Factors and Survival of Patients with Carcinoma of the Ampulla of Vater after Pancreaticoduodenectomy

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5563104/

  Although carcinoma of the ampulla of Vater (CAV) is a rare tumor, accounting for just 0.2% of gastrointestinal cancers, the survival of CAV patients is unfavorable. The five-year rates have ranged from 36.8-75.2% in previous reports but there is a lack of data relating to Thai people. […] The findings of the study indicate that the overall survival of CAV patients after surgery is quite fair, with a tendency for better outcome with early as compared to advanced lesions. The key prognostic factors were recurrence, moderate and poor differentiation, comorbidity and tumor size 2.0 cm. […] The overall 5 year survival rate of CAV patients was 33.3 months. Although overall median survival time was 75.3 months. The trend was that the early stages (stage IA, IB and IIA) had a higher median survival time than the advanced stages (stage IIB and III) (78.9 vs. 30.3 months, p = 0.066). […] The key prognostic factors were recurrence, moderate and poor differentiation, comorbidity and tumor size 2.0 cm.

• #22 Ampullary Cancer: Symptoms, Diagnosis & Outlook

  https://my.clevelandclinic.org/health/diseases/21905-ampullary-cancer

  As ampullary cancer forms so close to your liver, pancreas and other digestive system organs, it can easily spread to these areas. Treating ampullary cancer with surgery before it spreads offers the best outlook for the disease. […] The only potential cure for ampullary cancer is surgery that removes it completely. Curative treatments usually only work with early-stage cancers. If there’s no way to remove the tumor completely, your healthcare team can work with you on treatments to slow tumor growth and reduce your symptoms. […] Ampullary cancer is life-threatening, and survival rates decrease as the cancer stage increases. The five-year survival rate for people who receive the Whipple procedure ranges from 35% to 62%. This means that up to 62 out of 100 people who had the Whipple procedure for ampullary cancer are still alive after five years.

• #23 Ampullary Cancer: Symptoms, Diagnosis & Outlook

  https://my.clevelandclinic.org/health/diseases/21905-ampullary-cancer

  As ampullary cancer forms so close to your liver, pancreas and other digestive system organs, it can easily spread to these areas. Treating ampullary cancer with surgery before it spreads offers the best outlook for the disease. […] The only potential cure for ampullary cancer is surgery that removes it completely. Curative treatments usually only work with early-stage cancers. If there’s no way to remove the tumor completely, your healthcare team can work with you on treatments to slow tumor growth and reduce your symptoms. […] Ampullary cancer is life-threatening, and survival rates decrease as the cancer stage increases. The five-year survival rate for people who receive the Whipple procedure ranges from 35% to 62%. This means that up to 62 out of 100 people who had the Whipple procedure for ampullary cancer are still alive after five years.

• #24 The Clinical Benefit of Adjuvant Therapy in Long-Term Survival of Early-Stage Ampullary Carcinoma: A Single Institutional Experience | Manne | Journal of Clinical Medicine Research

  https://www.jocmr.org/index.php/JOCMR/article/view/4267/25893229

  The median OS and progression-free survival (PFS) for all the patients who had definitive surgery were 40.5 months and 28 months, respectively. […] In the early-stage AC with no high-risk features, adjuvant therapy did not improve the survival over surgery alone (40.5 vs. 51.7 months, P = 0.93). […] In the early-stage AC, adjuvant therapy may not improve the outcome in the short term but may benefit over a long period. […] The addition of radiation to CT did not yield improved outcome in early-stage cancers. […] The univariate analysis showed a statistically significant influence of pathological staging (P stage) 2, LN metastasis, PNE, and PPE on the OS and PFS. […] In the early-stage AC group, the median OS and PFS were 44.1 months and 40.5 months, respectively. […] There was no significant difference in the median OS for the patients who were on surveillance compared to those who received adjuvant therapy (40.5 vs. 51.7 months, P = 0.93).

• #25 The Clinical Benefit of Adjuvant Therapy in Long-Term Survival of Early-Stage Ampullary Carcinoma: A Single Institutional Experience | Manne | Journal of Clinical Medicine Research

  https://www.jocmr.org/index.php/JOCMR/article/view/4267/25893229

  The median PFS followed the same trend as the OS. Patients who received adjuvant therapy did not have any favorable outcome over the surgery alone (30.6 vs. 51.7 month, P = 0.71) in the first 5 years. […] In the present study, when compared to the adjuvant therapy (CT or CRT) group, the surveillance group did better in the first 5 years. […] The benefit of adding CRT to CT is inconclusive and needs to be validated in randomized trials.

• #26 The Clinical Benefit of Adjuvant Therapy in Long-Term Survival of Early-Stage Ampullary Carcinoma: A Single Institutional Experience | Manne | Journal of Clinical Medicine Research

  https://www.jocmr.org/index.php/JOCMR/article/view/4267/25893229

  The median OS and progression-free survival (PFS) for all the patients who had definitive surgery were 40.5 months and 28 months, respectively. […] In the early-stage AC with no high-risk features, adjuvant therapy did not improve the survival over surgery alone (40.5 vs. 51.7 months, P = 0.93). […] In the early-stage AC, adjuvant therapy may not improve the outcome in the short term but may benefit over a long period. […] The addition of radiation to CT did not yield improved outcome in early-stage cancers. […] The univariate analysis showed a statistically significant influence of pathological staging (P stage) 2, LN metastasis, PNE, and PPE on the OS and PFS. […] In the early-stage AC group, the median OS and PFS were 44.1 months and 40.5 months, respectively. […] There was no significant difference in the median OS for the patients who were on surveillance compared to those who received adjuvant therapy (40.5 vs. 51.7 months, P = 0.93).

• #27 The Clinical Benefit of Adjuvant Therapy in Long-Term Survival of Early-Stage Ampullary Carcinoma: A Single Institutional Experience | Manne | Journal of Clinical Medicine Research

  https://www.jocmr.org/index.php/JOCMR/article/view/4267/25893229

  The median PFS followed the same trend as the OS. Patients who received adjuvant therapy did not have any favorable outcome over the surgery alone (30.6 vs. 51.7 month, P = 0.71) in the first 5 years. […] In the present study, when compared to the adjuvant therapy (CT or CRT) group, the surveillance group did better in the first 5 years. […] The benefit of adding CRT to CT is inconclusive and needs to be validated in randomized trials.

• #28 Prognostic Factors and Survival of Patients with Carcinoma of the Ampulla of Vater after Pancreaticoduodenectomy

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5563104/

  Although carcinoma of the ampulla of Vater (CAV) is a rare tumor, accounting for just 0.2% of gastrointestinal cancers, the survival of CAV patients is unfavorable. The five-year rates have ranged from 36.8-75.2% in previous reports but there is a lack of data relating to Thai people. […] The findings of the study indicate that the overall survival of CAV patients after surgery is quite fair, with a tendency for better outcome with early as compared to advanced lesions. The key prognostic factors were recurrence, moderate and poor differentiation, comorbidity and tumor size 2.0 cm. […] The overall 5 year survival rate of CAV patients was 33.3 months. Although overall median survival time was 75.3 months. The trend was that the early stages (stage IA, IB and IIA) had a higher median survival time than the advanced stages (stage IIB and III) (78.9 vs. 30.3 months, p = 0.066). […] The key prognostic factors were recurrence, moderate and poor differentiation, comorbidity and tumor size 2.0 cm.

• #29 The Clinical Benefit of Adjuvant Therapy in Long-Term Survival of Early-Stage Ampullary Carcinoma: A Single Institutional Experience | Manne | Journal of Clinical Medicine Research

  https://www.jocmr.org/index.php/JOCMR/article/view/4267/25893229

  The median OS and progression-free survival (PFS) for all the patients who had definitive surgery were 40.5 months and 28 months, respectively. […] In the early-stage AC with no high-risk features, adjuvant therapy did not improve the survival over surgery alone (40.5 vs. 51.7 months, P = 0.93). […] In the early-stage AC, adjuvant therapy may not improve the outcome in the short term but may benefit over a long period. […] The addition of radiation to CT did not yield improved outcome in early-stage cancers. […] The univariate analysis showed a statistically significant influence of pathological staging (P stage) 2, LN metastasis, PNE, and PPE on the OS and PFS. […] In the early-stage AC group, the median OS and PFS were 44.1 months and 40.5 months, respectively. […] There was no significant difference in the median OS for the patients who were on surveillance compared to those who received adjuvant therapy (40.5 vs. 51.7 months, P = 0.93).

• #30 Ampullary Carcinoma: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/276413-overview

  Allema et al reported a 5-year overall survival rate of 50% in patients who underwent resection (subtotal or total pancreaticoduodenectomy) for ampullary cancer. Additionally, this series demonstrated that involvement of resection margins was the strongest prognostic factor for overall survival: patients with negative margins at resection had 5-year survival rates of up to 60%, compared with 15% in patients with positive margins (P 0.001). […] Unfortunately, most patients with carcinoma of the ampulla of Vater die of recurrent disease. Treatment fails in nearly 70% of patients with poor prognostic features, and these patients ultimately die of their disease.

• #31 Prognostic Factors for Long-Term Survival in Patients with Ampullary Carcinoma: The Results of a 15-Year Observation Period after Pancreaticoduodenectomy

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3958923/

  In the multivariate analysis lymphatic vessel invasion, intraoperative administration of PRBCs, and an elevated CA 19-9 level were identified as independent risk factors for a reduced long-term survival. […] The prognosis of ampullary carcinoma is clearly better than that of other carcinomas of the periampullary region. Nevertheless, the results of our study show that factors such as an increased tumor stage, considerable invasion depth of the tumor, positive lymph node involvement, blood vessel and lymphatic invasion of the tumor, and a CA 19-9 level higher than 37U/L are accompanied by a reduced long-term prognosis. Subsequent adjuvant therapy remains essential especially in patients with this constellation of risk factors.

• #32 Prognostic Factors and Survival of Patients with Carcinoma of the Ampulla of Vater after Pancreaticoduodenectomy

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5563104/

  Although carcinoma of the ampulla of Vater (CAV) is a rare tumor, accounting for just 0.2% of gastrointestinal cancers, the survival of CAV patients is unfavorable. The five-year rates have ranged from 36.8-75.2% in previous reports but there is a lack of data relating to Thai people. […] The findings of the study indicate that the overall survival of CAV patients after surgery is quite fair, with a tendency for better outcome with early as compared to advanced lesions. The key prognostic factors were recurrence, moderate and poor differentiation, comorbidity and tumor size 2.0 cm. […] The overall 5 year survival rate of CAV patients was 33.3 months. Although overall median survival time was 75.3 months. The trend was that the early stages (stage IA, IB and IIA) had a higher median survival time than the advanced stages (stage IIB and III) (78.9 vs. 30.3 months, p = 0.066). […] The key prognostic factors were recurrence, moderate and poor differentiation, comorbidity and tumor size 2.0 cm.

• #33 The role of lymph nodes in predicting the prognosis of ampullary carcinoma after curative resection | World Journal of Surgical Oncology | Full Text

  https://wjso.biomedcentral.com/articles/10.1186/s12957-015-0643-1

  Lymph node involvement is one of the well-demonstrated prognostic factors in ampullary carcinoma. The aim of this study is to clarify the role of lymph nodes in predicting the survival outcome of ampullary carcinoma. […] Concerning the node-associated variables, positive nodal status, positive lymph node number 2, THLN number 14, and LNR 0.15 were significantly associated with poorer survival outcomes, with a 5-year survival rate of 20.3, 38.9, 25.4, and 18 %, respectively. By multivariate analysis, nodal status and THLN number were two independent predictors of survival. […] Tumor biology reflected by lymph node status is the most important independent prognostic factor; nevertheless, surgical radicality based on THLN number also plays a significant role in the survival outcome for patients with ampullary carcinoma after curative pancreaticoduodenectomy.

• #34 Prognostic Factors for Long-Term Survival in Patients with Ampullary Carcinoma: The Results of a 15-Year Observation Period after Pancreaticoduodenectomy

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3958923/

  The overall 1-, 5-, 10-, and 15-year survival rates were 79%, 40%, 24%, and 10%, respectively. […] Survival analysis showed that positive lymph node involvement (P = 0.001), lymphatic vessel invasion (P = 0.0001), intraoperative administration of packed red blood cells (P = 0.03), an elevated CA 19-9 (P = 0.03), jaundice (P = 0.04), and an impaired patient condition (P = 0.01) are strong negative predictors for a reduced patient survival. […] Long-term survival depends strongly on lymphatic nodal and vessel involvement. Moreover, a preoperative elevated CA 19-9 proved to be a significant prognostic factor. […] After 1-, 5-, 10-, and 15-year periods, the overall survival of the examined patient population was 79%, 40%, 25%, and 10%, respectively, with a median survival term of 37 months.

• #35 Prognostic Factors for Long-Term Survival in Patients with Ampullary Carcinoma: The Results of a 15-Year Observation Period after Pancreaticoduodenectomy

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3958923/

  In the multivariate analysis lymphatic vessel invasion, intraoperative administration of PRBCs, and an elevated CA 19-9 level were identified as independent risk factors for a reduced long-term survival. […] The prognosis of ampullary carcinoma is clearly better than that of other carcinomas of the periampullary region. Nevertheless, the results of our study show that factors such as an increased tumor stage, considerable invasion depth of the tumor, positive lymph node involvement, blood vessel and lymphatic invasion of the tumor, and a CA 19-9 level higher than 37U/L are accompanied by a reduced long-term prognosis. Subsequent adjuvant therapy remains essential especially in patients with this constellation of risk factors.

• #36 The pathohistological subtype strongly predicts survival in patients with ampullary carcinoma | Scientific Reports

  https://www.nature.com/articles/s41598-019-49179-w

  The mean survival time for the pancreatobiliary subtype was 52 months, for the intestinal subtype 115 months, and for the mixed subtype 94 months (p=0.001). […] Therefore, the pancreatobiliary subtype shows a significantly poorer overall survival. […] A significantly worse 5-year survival rate was found for the pancreatobiliary subtype with 27.5% compared with the intestinal subtype with 61% (p=0.001). […] The subtype was also found to be an independent survival-predicting risk factor (HR: 0.45, p=0.022) in our study. […] The poorer prognosis of the pancreatobiliary subtype could probably be explained by a disseminating growth behavior, perineural sheet invasion, and by a distinct desmoplastic stromal reaction. […] The better prognosis of the intestinal subtype could be explained by its precursor lesions, which arise from preexisting adenomas following the adenoma-dysplasia-adenocarcinoma sequence. […] The pancreatobiliary subtype is associated with poor prognosis and a higher rate of lymph node metastasis, whereas the intestinal subtype shows an excellent prognosis.

• #37 The role of lymph nodes in predicting the prognosis of ampullary carcinoma after curative resection | World Journal of Surgical Oncology | Full Text

  https://wjso.biomedcentral.com/articles/10.1186/s12957-015-0643-1

  The best survival outcome was seen in patients with negative nodal status and THLN 14 with a favorable 5-year survival rate of 84.4 %, which was much better than that of patients in other categories. […] Lymph node involvement might imply that the tumor behavior changes on its way from confinement in origin organ toward distant metastasis. […] In our study cohort, patients with positive lymph node status had significant higher stage, larger tumor size, higher grade of cell differentiation, presence of perineural invasion, and lymphovascular invasion (all P0.05, Table 3). All these findings indicated that tumors in patients with positive nodal status have the tendency toward poorer prognosis. […] Since THLN number and nodal status were both independent prognostic factors of ampullary carcinoma, as expected, patient with THLN number 14 and negative nodal status had the most favorable survival outcome in this study. In contrast, patients with THLN number 14 and positive nodal status had poorest survival outcome. […] Lymph node status which could indicate tumor biology is the most powerful independent prognostic factor for patients with ampullary carcinoma undergoing curative resection. Nevertheless, THLN number is also an independent prognostic factor.

• #38 Prognostic Factors for Long-Term Survival in Patients with Ampullary Carcinoma: The Results of a 15-Year Observation Period after Pancreaticoduodenectomy

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3958923/

  In the multivariate analysis lymphatic vessel invasion, intraoperative administration of PRBCs, and an elevated CA 19-9 level were identified as independent risk factors for a reduced long-term survival. […] The prognosis of ampullary carcinoma is clearly better than that of other carcinomas of the periampullary region. Nevertheless, the results of our study show that factors such as an increased tumor stage, considerable invasion depth of the tumor, positive lymph node involvement, blood vessel and lymphatic invasion of the tumor, and a CA 19-9 level higher than 37U/L are accompanied by a reduced long-term prognosis. Subsequent adjuvant therapy remains essential especially in patients with this constellation of risk factors.

• #39 The Optimal Cutoff Value of Tumor Markers for Prognosis Prediction in Ampullary Cancer

  https://www.mdpi.com/2072-6694/15/8/2281

  The optimal cutoff value for CA 19-9 was found to be 46 U/mL. This new cutoff value was a statistically significant prognostic factor for AC and may be used to evaluate the prognosis of AC and determine treatment strategies such as surgical treatments and adjuvant chemotherapy. […] The new cutoff value of CA 19-9 46 U/mL may be used for evaluating the prognosis of AC. Therefore, it may be an effective indicator for determining treatment strategies such as surgical treatments and adjuvant chemotherapy. […] The prognostic factors for AC were CA 19-9, histologic grade, N stage, and history of adjuvant chemotherapy, and as a tumor marker cutoff value, the CA 19-9 level 46 U/mL rather than 36 U/mL showed statistically significant results. Therefore, tumor markers can be used as important reference data when deciding treatment policies for patients with AC.

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