title: A retrospective study of ampullary adenocarcinomas: overall survival and responsiveness to fluoropyrimidine-based chemotherapy.
abstract: BACKGROUND
  Whether carcinomas of the ampulla of Vater should be classified with biliary tract tumors and treated in a similar manner remains unknown. We sought to compare the outcomes of similarly staged periampullary adenocarcinomas (AAs) and analyze the chemotherapy responsiveness of AAs.
  
  
  METHODS
  A total of 905 patients with resected periampullary adenocarcinomas were identified from a prospective surgical registry from 1988 to 2010. A second cohort of 64 metastatic AA patients from 1992 to 2009 who received either front-line fluoropyrimidine-based or gemcitabine-based chemotherapy was also identified.
  
  
  RESULTS
  Overall survival (OS) for AAs was similar to survival with duodenal adenocarcinomas, but was significantly different from both extrahepatic biliary and pancreatic adenocarcinomas (P < 0.001 for each comparison). In multivariate analysis, AAs had a significantly improved OS in comparison with extrahepatic biliary adenocarcinomas (HR = 1.97, P = 0.006). Fluoropyrimidine-based as opposed to gemcitabine-based chemotherapy for metastatic AAs resulted in a significant improvement in time to progression (P = 0.001) but only a trend toward benefit for OS (P = 0.07) in multivariate analysis.
  
  
  CONCLUSIONS
  Differences in the natural history of ampullary and extrahepatic biliary adenocarcinomas exist. Analyses of metastatic ampullary adenocarcinomas suggest that fluoropyrimidine-based chemotherapy may represent a more appropriate front-line chemotherapy approach.
authors.affiliation: Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, 1515Holcombe Blvd. Houston, TX 77030, USA.
authors.forename: Z-Q
authors.initials: ZQ
authors.lastname: Jiang
authors.forename: G
authors.initials: G
authors.lastname: Varadhachary
authors.forename: X
authors.initials: X
authors.lastname: Wang
authors.forename: S
authors.initials: S
authors.lastname: Kopetz
authors.forename: J E
authors.initials: JE
authors.lastname: Lee
authors.forename: H
authors.initials: H
authors.lastname: Wang
authors.forename: R
authors.initials: R
authors.lastname: Shroff
authors.forename: M
authors.initials: M
authors.lastname: Katz
authors.forename: R A
authors.initials: RA
authors.lastname: Wolff
authors.forename: J
authors.initials: J
authors.lastname: Fleming
authors.forename: M J
authors.initials: MJ
authors.lastname: Overman
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery; D014670:Ampulla of Vater / Q000473:pathology*; D000964:Antimetabolites, Antineoplastic / Q000627:therapeutic use; D003138:Common Bile Duct Neoplasms / Q000188:drug therapy* / Q000401:mortality* / Q000601:surgery; D003841:Deoxycytidine / Q000031:analogs & derivatives / Q000627:therapeutic use; D004379:Duodenal Neoplasms / Q000188:drug therapy* / Q000401:mortality* / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D010190:Pancreatic Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000601:surgery; D011743:Pyrimidines / Q000627:therapeutic use*; D012189:Retrospective Studies; D013534:Survival; D016896:Treatment Outcome; D000093542:Gemcitabine
chemical_list: D000964:Antimetabolites, Antineoplastic; D011743:Pyrimidines; D003841:Deoxycytidine; C029269:5-fluoropyrimidine; D000093542:Gemcitabine
keywords: ampullary adenocarcinomas; chemotherapy; fluoropyrimidine; gemcitabine; periampullary