title: Adenocarcinoma of the ampulla of Vater: T-stage, chromosome 17p allelic loss, and extended pancreaticoduodenectomy are relevant prognostic factors.
abstract: OBJECTIVE
  To evaluate the prognostic significance of different clinico-pathological and molecular factors, and to compare survival after standard and extended pancreaticoduodenectomy (PD) in ampulla of Vater adenocarcinoma (AVAC). There are discordant data on factors affecting prognosis, and hence therapeutic choices, in AVAC.
  
  
  METHODS
  Clinical-pathological factors were evaluated in 59 patients, subjected to PD for AVAC; in 42 subjects information on chromosome 17p and 18q allelic losses (LOH) and microsatellite instability (MSI) was also available. The association between survival and type of PD was investigated in the 25 patients operated between 1990 and 2001 (16 standard and nine extended).
  
  
  RESULTS
  The overall 5- and 10-year tumor-related survival rates were 46% and 33%, respectively. Sixteen patients had T-stages 1-2, 14 T-stage 3, and 29 T-stage 4 cancers. Chromosome 17p and 18q LOH were detected in 23 (55%) and 15 cases (36%), respectively, and in 12 cases (29%) coexisted. Five cases were MSI-positive (12%). At univariate analysis, poor survival was associated with cancer ulceration (P = 0.051), poor differentiation (P = 0.008), T-stage 4 (P < 0.001), nodal metastases (P = 0.004), chromosome 17p (P < 0.001) and 18q LOH (P = 0.002), and absence of MSI (P = 0.009). At multivariate analysis, only T-stage (P = 0.002) and 17p LOH (P = 0.001) were independent predictors of survival. All patients with MSI-positive cancers were long-survivors (>12 yrs), whereas only 30% of MSI-negative cancer patients survived at 5 years. Extended pancreaticoduodenectomy was associated with a 3-year disease-related survival higher than standard resection (83% vs 31%; P = 0.018).
  
  
  CONCLUSIONS
  MSI and chromosome 17p status allow to better define prognosis within ampullary cancers at the same stage. Surgery alone resulted curative in MSI-positive cancer patients, whereas it was inadequate in patients showing allelic losses, who might benefit from adjuvant therapy. In this observational study, extended PD was associated with increased survival compared to standard procedures.
authors.affiliation: Department of Surgery and Gastroenterology, University of Verona Medical School, Verona, Italy. Calogero.Iacono@univr.it
authors.forename: Calogero
authors.initials: C
authors.lastname: Iacono
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Verlato
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Zamboni
authors.forename: Aldo
authors.initials: A
authors.lastname: Scarpa
authors.forename: Ettore
authors.initials: E
authors.lastname: Montresor
authors.forename: Paola
authors.initials: P
authors.lastname: Capelli
authors.forename: Luca
authors.initials: L
authors.lastname: Bortolasi
authors.forename: Giovanni
authors.initials: G
authors.lastname: Serio
mesh_terms: D000230:Adenocarcinoma / Q000235:genetics / Q000473:pathology* / Q000601:surgery; D000368:Aged; D014670:Ampulla of Vater / Q000473:pathology* / Q000601:surgery; D002886:Chromosomes, Human, Pair 17 / Q000235:genetics*; D002887:Chromosomes, Human, Pair 18 / Q000235:genetics; D003138:Common Bile Duct Neoplasms / Q000235:genetics / Q000473:pathology* / Q000601:surgery; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D019656:Loss of Heterozygosity / Q000235:genetics*; D008207:Lymphatic Metastasis / Q000473:pathology; D008297:Male; D053842:Microsatellite Instability; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D016577:Pancreaticoduodenectomy; D011379:Prognosis; D015996:Survival Rate