title: Prognostic score for recurrence after Whipple's pancreaticoduodenectomy for ampullary carcinomas; results of an AGEO retrospective multicenter cohort.
abstract: BACKGROUND
  Ampullary carcinoma (AC) is a relatively rare entity often managed as a biliopancreatic carcinoma. AC has a better prognosis than peri ampullary tumors after resection, but more than a third of patients relapse. Factors predictive of recurrence are controversial, mainly because the relevant studies are very small or also included non AC tumors. There are no guidelines on the use of adjuvant or neoadjuvant chemotherapy. The aim of this study was to identify prognostic factors for recurrence after AC resection in a large multicentric cohort, and to establish a simple, practical, predictive score for recurrence in order to guide multidisciplinary decisions.
  
  
  METHODS
  We included 152 consecutive patients who underwent Whipple's pancreaticoduodenectomy for ampullary carcinoma from January 2000 to December 2010 in 10 gastrointestinal oncology departments.
  
  
  RESULTS
  The estimated overall 5-year disease-free survival rate (DFS) was 47.1%. In multivariate analysis, age≥ 75 years at diagnosis (p < 0.0001), poor general condition (p = 0.01), poorly (p = 0.005) or moderately differentiated tumors (p = 0.01) and TNM stage IIb or III (p = 0.05) were associated with poor DFS. Based on this multivariate analysis, we developed a prognostic score with three levels of risk: DFS at 5 years was 73.5% in the low-risk group and 20.1% in the high-risk group.
  
  
  CONCLUSIONS
  This simple score based on age, general condition, tumor differentiation and TNM stage can classify patients into subgroups with different risks of recurrence and could help with therapeutic decisionmaking.
authors: Department of Gastroenterology and Gastrointestinal Oncology, European Hospital Georges Pompidou, 20 rue Leblanc, 75015 Paris, France.
authors: O
authors: O
authors: Colussi
authors: Department of Gastrointestinal Surgery, European Hospital Georges Pompidou, 20 rue Leblanc, 75015 Paris, France.
authors: T
authors: T
authors: Voron
authors: Methodological and Quality of Life Unit in Oncology, Besançon University Hospital, 2 Place St Jacques, 25030 Besancon France.
authors: A
authors: A
authors: Pozet
authors: Department of Gastroenterology and Pancreatology, Beaujon Hospital, 100 Bd du Général Leclerc, 92110 Clichy, France.
authors: P
authors: P
authors: Hammel
authors: Department of Gastrointestinal Surgery, Beaujon Hospital, 100 Bd du Général Leclerc, 92110 Clichy, France.
authors: A
authors: A
authors: Sauvanet
authors: Department of Gastroenterology and Gastrointestinal Oncology, Pitié Salpetrière Hospital, 47-83 boulevard de l'Hopital, 75013 Paris, France.
authors: J B
authors: JB
authors: Bachet
authors: Department of Gastrointestinal Surgery, Pitié Salpetrière Hospital, 47-83 bd de l'Hôpital, 75013 Paris, France.
authors: J C
authors: JC
authors: Vaillant
authors: Department of Gastroenterology and Gastrointestinal Oncology, European Hospital Georges Pompidou, 20 rue Leblanc, 75015 Paris, France.
authors: Ph
authors: P
authors: Rougier
authors: Department of Gastrointestinal Surgery, Ambroise Pare Hospital, 9 av Charles de Gaulle, 92100 Boulogne-Billancourt, France.
authors: B
authors: B
authors: Nordlinger
authors: Department of Gastrointestinal Surgery, European Hospital Georges Pompidou, 20 rue Leblanc, 75015 Paris, France.
authors: A
authors: A
authors: Berger
authors: Department of Gastroenterology, Cochin Hospital, 27 rue du Faubourg Saint Jacques, 75014 Paris, France.
authors: R
authors: R
authors: Coriat
authors: Department of Gastrointestinal Surgery, Cochin Hospital, 27 rue du Faubourg Saint Jacques, 75014 Paris, France.
authors: B
authors: B
authors: Dousset
authors: Department of Gastrointestinal Oncology, Institut Gustave Roussy, 114 rue Edouard Vaillant, 94805 Villejuif, France.
authors: D
authors: D
authors: Malka
authors: Department of Gastrointestinal Oncology, Saint Antoine Hospital, 184 rue du Faubourg saint Antoine, 75012 Paris, France.
authors: T
authors: T
authors: André
authors: Department of Gastrointestinal Surgery, Saint Antoine Hospital, 184 rue rue du Faubourg saint Antoine, 75012 Paris, France.
authors: F
authors: F
authors: Paye
authors: Department of Gastroenterology, Avicenne Hospital, 125 rue de Stalingrad, 93000 Bobigny, France.
authors: T
authors: T
authors: Aparicio
authors: Department of Gastroenterology, Centre Hospitalier de Meaux, 8 rue Saint-Fiacre, 97100 Meaux, France.
authors: C
authors: C
authors: Locher
authors: Department of Oncology, Les Diaconnesses Hospital, 18 rue du Sergent Bauchat, 75012 Paris, France.
authors: D
authors: D
authors: Cojean Zeleck
authors: Department of Gastroenterology and Gastrointestinal Oncology, European Hospital Georges Pompidou, 20 rue Leblanc, 75015 Paris, France.
authors: L
authors: L
authors: Tchinou
authors: Methodological and Quality of Life Unit in Oncology, Besançon University Hospital, 2 Place St Jacques, 25030 Besancon France.
authors: F
authors: F
authors: Bonnetain
authors: Department of Gastroenterology and Gastrointestinal Oncology, European Hospital Georges Pompidou, 20 rue Leblanc, 75015 Paris, France. Electronic address: jtaieb75@gmail.com.
authors: J
authors: J
authors: Taieb
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D014670:Ampulla of Vater; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use; D002277:Carcinoma / Q000473:pathology* / Q000628:therapy*; D059186:Chemoradiotherapy, Adjuvant; D017024:Chemotherapy, Adjuvant; D003138:Common Bile Duct Neoplasms / Q000473:pathology* / Q000628:therapy*; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D018572:Disease-Free Survival; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006304:Health Status; D006801:Humans; D002955:Leucovorin / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D009944:Organoplatinum Compounds / Q000008:administration & dosage; D016577:Pancreaticoduodenectomy; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods; D015996:Survival Rate; D000093542:Gemcitabine
chemical_list: D009944:Organoplatinum Compounds; D003841:Deoxycytidine; D002955:Leucovorin; D005472:Fluorouracil; D000093542:Gemcitabine
keywords: Ampulla of Vater; Ampullary carcinoma; Prognostic factors; Recurrence score