Population-Based Cohort Study on Treatment and Overall Survival of Patients Clinically Diagnosed With T1 Ampullary Cancer.

Autor:	de Wilde AJ; Department of Surgery and School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, the Netherlands., de Jong EJM; Department of Internal Medicine, Division of Medical Oncology, GROW-Research Institute for Oncology & Reproduction, Maastricht University Medical Center+, Maastricht, the Netherlands., Bruno MJ; Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, Netherlands., Besselink MG; Amsterdam UMC, location University of Amsterdam, Department of Surgery, Amsterdam, the Netherlands.; Cancer Center Amsterdam, the Netherlands., van der Geest LGM; Department of Research and Development, Netherlands Comprehensive Cancer Organization (IKNL), the Netherlands., Geurts SME; Department of Internal Medicine, Division of Medical Oncology, GROW-Research Institute for Oncology & Reproduction, Maastricht University Medical Center+, Maastricht, the Netherlands., Groot Koerkamp B; Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, the Netherlands., de Hingh IHJT; Department of Internal Medicine, Division of Medical Oncology, GROW-Research Institute for Oncology & Reproduction, Maastricht University Medical Center+, Maastricht, the Netherlands.; Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands., de Meijer VE; Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands., Miclea RL; Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands., Poley JW; Department of Gastroenterology, Maastricht University Medical Center+, Maastricht, the Netherlands., Samarska IV; Department of Pathology, Maastricht University Medical Center+, Maastricht, the Netherlands., van Santvoort HC; Department of Surgery, St Antonius Hospital, Nieuwegein, Netherlands; Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands., Stommel MWJ; Department of Surgery, Radboud University Medical Center, Nijmegen, the Netherlands., Voermans RP; Cancer Center Amsterdam, the Netherlands.; Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands., Olde Damink SWM; Department of Surgery and School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, the Netherlands.; Department of Surgery, Maastricht University Medical Center+, Maastricht, the Netherlands., de Vos-Geelen J; Department of Internal Medicine, Division of Medical Oncology, GROW-Research Institute for Oncology & Reproduction, Maastricht University Medical Center+, Maastricht, the Netherlands., Bouwense SAW; Department of Surgery and School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, the Netherlands.; Department of Surgery, Maastricht University Medical Center+, Maastricht, the Netherlands.
Jazyk:	angličtina
Zdroj:	Annals of surgery [Ann Surg] 2024 Oct 14. Date of Electronic Publication: 2024 Oct 14.
DOI:	10.1097/SLA.0000000000006563
Abstrakt:	Objective: To evaluate treatment outcomes, overall survival (OS), and prognostic factors for OS in patients diagnosed with T1 ampullary cancer. Background: Ampullary cancer is a rare gastrointestinal malignancy with limited data from large cohorts, especially regarding T1 disease. Methods: Patients diagnosed with clinical (c) T1 ampullary cancer and patients with pathological (p) T1 in the case of cTx were included from the Netherlands Cancer Registry (2014-2021). Primary endpoint was OS, analyzed using the Kaplan-Meier estimator. Multivariable Cox proportional hazards regression was used to identify OS predictors. Results: Overall, 244 patients with cT1 ampullary cancer were included, of whom 75% (n=184) underwent resection. Among these, 68% (n=125) were upstaged to a higher pathologically T classification (pT2:40%, pT3:22%, pT4:5%). Similarly, cN0 was upstaged to pN1 in 47% of patients (n=87). Next, 100 patients with pT1 and cTx ampullary cancer were included, making a total of 159 patients with pT1 tumor. 92% (146/159) underwent pancreatoduodenectomy while 8% (13/159) underwent endoscopic or local surgical resection. The 1- and 5-year OS for cT1N0 ampullary cancer were 72% and 36%, while for pT1N0 they were 94% and 75%. Independent poor prognostic factors for OS were pN1 classification (HR 2.12; 95%CI 1.15-3.94, P=0.017), pNx classification (i.e. locally resected patients) (HR 2.82; 95%CI 1.22-6.55, P=0.016), and poorly differentiated tumors (HR 4.05; 95%CI 1.33-12.40, P=0.014). Conclusion: In patients with cT1 ampullary cancer, more than two-thirds had a pathologically higher T classification, and almost half had a pathologically higher N classification. These findings suggest that pancreatoduodenectomy is recommended for cT1 ampullary cancer. Competing Interests: Conflicts of interest: J.d.V.G. has served as a consultant for Amgen, AstraZeneca, MSD, Pierre Fabre, and Servier, and has received institutional research funding from Servier. All outside the submitted work. S.M.E.G. reports institutional grants from Roche, Pfizer, Novartis, Eli Lilly, Daiichi Sankyo, Gilead and AstraZeneca. All outside the submitted work. M.J.B. has served as a consultant for Boston Scientific, Cook Medical, Pentax Medical and AMBU, and has received institutional funding from Boston Scientific, Cook Medical, Pentax Medical, Mylan, AMBU, and ChiRoStim, all outside the submitted work. I.H.J.T.d.H. received a research grant, paid to the institute from RanD Biotech for research not related to the submitted work. M.G.B. received research grants for investigator-initated trials from Intuitive Surgical, Medtronic, Oncosil, and Ethicon not related to the submitted work. The other authors have declared no conflicts of interest. (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)
Databáze:	MEDLINE
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