A simple prognostic score to predict recurrence after pancreaticoduodenectomy for ampullary carcinoma: results from the French prospective FFCD-AC cohort

G Roth ¹, A Pellat ², G Piessen ³

¹University Grenoble Alpes/Hepato-Gastroenterology and Digestive Oncology Department, CHU Grenoble Alpes/Institute for Advanced Biosciences, CNRS UMR 5309-INSERM U1209, Grenoble, France.
²Service de gastroentérologie, d'endoscopie et d'oncologie digestive, Hôpital Cochin, APHP, Paris, France; Centre of Research in Epidemiology and Statistics (CRESS), Université Paris Cité, INSERM U1153, Paris, France.
³University of Lille/Cancer Heterogeneity Plasticity and Resistance to Therapies, UMR9020-U1277 INSERM-CNRS/Digestive Surgery Department, CHU Lille, Lille, France.
⁴Fédération Francophone de Cancérologie Digestive (FFCD), EPICAD INSERM LNC-UMR 1231, Faculté de Médecine, University of Burgundy and Franche Comté, Dijon, France.
⁵Department of Digestive Surgery, Charles Nicolle Hospital, Rouen, France.
⁶Institut du Cancer Paris CARPEM, APHP, Hepatogastroenterology and GI Oncology Department, APHP Centre-Université Paris Cité, Hôpital Européen G. Pompidou, Paris, France.
⁷Hepato-Gastroenterology Department, Poitiers University Hospital, Poitiers, France.
⁸Department of Gastroenterology and Digestive Oncology, CHU Amiens-Picardie, Amiens, France.
⁹Department of Digestive Oncology and Hepatobiliary Surgery, CHU Estaing, Clermont-Ferrand, France.
¹⁰Department of Digestive Surgery and Surgical Oncology, Bicêtre Hospital, AP-HP, Paris-Saclay University, Le Kremlin Bicêtre, France.
¹¹Department of Hepatology, Gastroenterology and Digestive Oncology, Centre Hospitalier de Vendée, La Roche sur Yon, France.
¹²Department of Hepatology, Gastroenterology and Digestive Oncology, Saint Malo General Hospital, Saint Malo, France.
¹³Department of Gastroenterology, Nancy University Hospital, University of Lorraine, Nancy, France.
¹⁴Hepatogastroenterology Department, University Hospital, Tours, France and INSERM UMR 1069, Tours University, Tours, France.
¹⁵Department of Gastroenterology and Digestive Oncology, Hospices civils de Lyon, CHU de la Croix Rousse, Lyon, France.
¹⁶Gastroenterology and Digestive Oncology Department, Meaux General Hospital, Meaux, France.
¹⁷Oncology Department, Louis Pasteur Hospital, Chartres, France.
¹⁸Fédération Francophone de Cancérologie Digestive (FFCD), EPICAD INSERM LNC-UMR 1231, Faculté de Médecine, University of Burgundy and Franche Comté, Dijon, France; Hepatology and Gastroenterology Unit, Dijon University Hospital/INSERM U1231/University of Burgundy Dijon, Dijon, France.
¹⁹Gastroenterology and Digestive Oncology Department, Université Reims Champagne Ardenne, CHU Reims, Reims, France.

⁰University Grenoble Alpes/Hepato-Gastroenterology and Digestive Oncology Department, CHU Grenoble Alpes/Institute for Advanced Biosciences, CNRS UMR 5309-INSERM U1209, Grenoble, France.

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November 19, 2024

View abstract on PubMed

Summary

A new prognostic score for ampullary carcinoma (AC) identifies patients at high risk of recurrence. This score, based on tumor stage, grade, and subtype, aids in adjuvant treatment decisions for AC patients.

Area Of Science

Gastroenterology
Oncology
Surgical Oncology

Background

Ampullary carcinoma (AC) is a rare gastrointestinal cancer with a significant recurrence rate (~40%) post-surgery.
Prognostic factors and adjuvant treatment strategies for AC remain debated, impacting patient outcomes.

Purpose Of The Study

To identify prognostic factors for disease-free survival (DFS) and overall survival (OS) in resected AC.
To develop a user-friendly score to predict recurrence risk in AC patients.
To evaluate the benefit of adjuvant therapy on DFS and OS.

Main Methods

Analysis of the French nationwide prospective FFCD-AC cohort of 370 patients with non-metastatic resected AC.
Multivariable analysis to identify factors associated with DFS and OS.
Development of a prognostic score and propensity score matching to assess adjuvant chemotherapy efficacy.

Main Results

Stage III tumor, high tumor grade, and non-intestinal subtype were significantly associated with shorter DFS.
The developed score stratified patients into low, intermediate, and high-risk groups with distinct DFS and OS.
Adjuvant chemotherapy was associated with significantly longer DFS in the matched cohort.

Conclusions

An integrated prognostic score using lymph node invasion, tumor grade, and non-intestinal subtypes is a valuable tool for resected AC.
This score aids in risk stratification and can inform adjuvant treatment decisions.
External validation is recommended to confirm the score's prognostic utility.

Keywords:

adjuvant therapy ampullary carcinoma prognostic score tumor recurrence