title: The influence of prognostic factors and adjuvant chemoradiation on survival after pancreaticoduodenectomy for ampullary carcinoma.
abstract: BACKGROUND
  The prognosis after pancreaticoduodenectomy (PD) for ampullary carcinoma (AC) is superior to that of pancreatic cancer. Decisions regarding adjuvant therapy are influenced by factors such as nodal status, stage, and grade, but the influence of these individual variables on survival is unclear.
  
  
  METHODS
  A prospective tumor registry database was queried to identify patients who underwent PD for AC at Thomas Jefferson University between Jan 1997 and Apr 2009. The study was conducted with the approval of the institutional review board. Data were collected through review of hospital and departmental charts. Overall survival (OS) was analyzed using univariate and multivariate Cox proportional hazard models. The proportional hazard assumption was verified for the overall model and individual covariates.
  
  
  RESULTS
  A total of 61 patients underwent PD for AC at our institution. There were five perioperative deaths (8.2%). Mean age was 70 years (62% male). Median survival time (MST) was 50 months for all patients. Only primary tumor stage, T1/T2 versus T3/T4 (American Joint Committee on Cancer Staging, version 6), was associated with OS in univariate analyses (p = 0.003). The association of nodal status with OS was borderline-significant (p = 0.08), with the MST being 84 months for node-negative and 17 months for node-positive patients. The remaining covariates were not predictors of OS. In the multivariate analysis, only primary tumor stage (HR, 5.1; p < 0.001) and age (HR, 1.04; p = 0.06), but not nodal status or adjuvant therapy, were associated with overall survival.
  
  
  CONCLUSIONS
  Advanced primary tumor stage and age were associated with inferior OS after PD for AC. Adjuvant therapy did not impact survival. Patients with advanced tumor stage should be considered for clinical trials of adjuvant therapy after PD with novel compounds and optimized radiation therapy strategies.
authors.affiliation: Department of Radiation Oncology, Jefferson Medical College of Thomas Jefferson University, Kimmel Cancer Center, Philadelphia, PA, USA.
authors.forename: Timothy N
authors.initials: TN
authors.lastname: Showalter
authors.forename: Tingting
authors.initials: T
authors.lastname: Zhan
authors.forename: P Rani
authors.initials: PR
authors.lastname: Anne
authors.forename: Inna
authors.initials: I
authors.lastname: Chervoneva
authors.forename: Edith P
authors.initials: EP
authors.lastname: Mitchell
authors.forename: Charles J
authors.initials: CJ
authors.lastname: Yeo
authors.forename: Ernest L
authors.initials: EL
authors.lastname: Rosato
authors.forename: Eugene P
authors.initials: EP
authors.lastname: Kennedy
authors.forename: Adam C
authors.initials: AC
authors.lastname: Berger
mesh_terms: D000367:Age Factors; D000368:Aged; D014670:Ampulla of Vater / Q000473:pathology*; D000964:Antimetabolites, Antineoplastic / Q000627:therapeutic use; D000069287:Capecitabine; D002277:Carcinoma / Q000473:pathology* / Q000628:therapy*; D017024:Chemotherapy, Adjuvant; D003138:Common Bile Duct Neoplasms / Q000473:pathology* / Q000628:therapy*; D003841:Deoxycytidine / Q000031:analogs & derivatives / Q000627:therapeutic use; D005260:Female; D005472:Fluorouracil / Q000031:analogs & derivatives / Q000627:therapeutic use; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D016577:Pancreaticoduodenectomy; D011379:Prognosis; D016016:Proportional Hazards Models; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D013997:Time Factors; D000093542:Gemcitabine
chemical_list: D000964:Antimetabolites, Antineoplastic; D003841:Deoxycytidine; D000069287:Capecitabine; D005472:Fluorouracil; D000093542:Gemcitabine