Journal of hepato-biliary-pancreatic sciences · 2026
Histopathologic Subtype as a Determinant of Prognosis and Chemotherapy Benefit in Resected Ampullary Adenocarcinoma.
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Pellegrini Riccardo, Del Chiaro Valentina, Franco Salvador Rodriguez, Ishida Hiroyuki, Nara Atsushi, Galvez Karla Navarrete, Mungo Benedetto, Del Chiaro Marco, Schulick Richard D
Аннотация
BACKGROUND: Ampullary adenocarcinoma (AAC) is a rare malignancy with heterogeneous biological behavior. Although surgical resection is the only potentially curative option, the prognostic role of histopathologic features and adjuvant chemotherapy (AC) remains unclear.
METHODS: Consecutive patients undergoing curative-intent pancreatoduodenectomy for AAC at the University of Colorado Hospital between January 2013 and May 2025 were retrospectively reviewed. Clinicopathologic variables associated with overall (OS) and recurrence-free survival (RFS) were analyzed using multivariable Cox regression.
RESULTS: Ninety-seven patients were included. Median OS was 93.9 months with 1-, 3-, 5-, and 10-year OS rates of 89%, 67%, 59%, and 46%. Older age (HR, 3.79; 95% CI, 1.71-8.41), lymph node (LN) involvement (HR, 4.92; 95% CI, 1.87-12.93), and R1 margin (HR, 4.33; 95% CI, 1.09-17.25) independently predicted poorer OS. The pancreatobiliary subtype (pbAAC) showed worse OS than the intestinal subtype (iAAC) (5-year OS, 48% vs. 75%; p = 0.012). In pbAAC, LN metastasis (HR, 4.16; 95% CI, 1.31-13.18) and R1 margin (HR, 5.47; 95% CI, 1.10-27.20) predicted worse OS, whereas AC was associated with improved survival (HR, 0.404; 95% CI, 0.18-0.91). No AC benefit was observed in iAAC (p = 0.323).
CONCLUSIONS: Histopathologic subtype is a key prognostic factor in AAC, with AC associated with better survival in pbAAC.
METHODS: Consecutive patients undergoing curative-intent pancreatoduodenectomy for AAC at the University of Colorado Hospital between January 2013 and May 2025 were retrospectively reviewed. Clinicopathologic variables associated with overall (OS) and recurrence-free survival (RFS) were analyzed using multivariable Cox regression.
RESULTS: Ninety-seven patients were included. Median OS was 93.9 months with 1-, 3-, 5-, and 10-year OS rates of 89%, 67%, 59%, and 46%. Older age (HR, 3.79; 95% CI, 1.71-8.41), lymph node (LN) involvement (HR, 4.92; 95% CI, 1.87-12.93), and R1 margin (HR, 4.33; 95% CI, 1.09-17.25) independently predicted poorer OS. The pancreatobiliary subtype (pbAAC) showed worse OS than the intestinal subtype (iAAC) (5-year OS, 48% vs. 75%; p = 0.012). In pbAAC, LN metastasis (HR, 4.16; 95% CI, 1.31-13.18) and R1 margin (HR, 5.47; 95% CI, 1.10-27.20) predicted worse OS, whereas AC was associated with improved survival (HR, 0.404; 95% CI, 0.18-0.91). No AC benefit was observed in iAAC (p = 0.323).
CONCLUSIONS: Histopathologic subtype is a key prognostic factor in AAC, with AC associated with better survival in pbAAC.