Clinicopathologic Analysis and Prognostic Factors for Survival in Patients with Operable Ampullary Carcinoma: A Multi-Institutional Retrospective Experience

In ampullary cancer, 5-year survival rates are 30-50%, even with optimal resection and perioperative systemic therapies. We sought to determine the important clinicopathological features and adjuvant treatments in terms of the prognosis of patients with operable-stage ampullary carcinomas. We included 197 patients who underwent pancreaticoduodenectomy to treat ampullary carcinomas between December 2003 and May 2019. Demographics, clinical features, treatments, and outcomes/survival were analyzed. The median disease-free survival (mDFS) and median overall survival (mOS) were 40.9 vs. 63.4 months, respectively. The mDFS was significantly lower in patients with lymphovascular invasion ( < 0.001) and lymph node involvement ( = 0.027). Potential predictors of decreased OS on univariate analysis included age ≥ 50 years ( = 0.045), poor performance status ( = 0.048), weight loss ( = 0.045), T3-T4 tumors ( = 0.018), surgical margin positivity ( = 0.01), lymph node involvement ( = 0.001), lymphovascular invasion ( < 0.001), perineural invasion ( = 0.007), and poor histological grade ( = 0.042). For the multivariate analysis, only nodal status (hazard ratio [HR]1.98; 95% confidence interval [CI], 1.08-3.65; = 0.027) and surgical margin status (HR 2.61; 95% CI, 1.09-6.24; = 0.03) were associated with OS. Nodal status and a positive surgical margin were independent predictors of a poor mOS for patients with ampullary carcinomas. Additional studies are required to explore the role of adjuvant therapy in patients with ampullary carcinomas.