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Prognostic factors for long-term survival in patients with ampullary carcinoma: the results of a 15-year observation period after pancreaticoduodenectomy.

Klein F, Jacob D, Bahra M, Pelzer U, Puhl G, Krannich A, Andreou A, Gül S, Guckelberger O - HPB Surg (2014)

Bottom Line: Survival analysis showed that positive lymph node involvement (P = 0.001), lymphatic vessel invasion (P = 0.0001), intraoperative administration of packed red blood cells (P = 0.03), an elevated CA 19-9 (P = 0.03), jaundice (P = 0.04), and an impaired patient condition (P = 0.01) are strong negative predictors for a reduced patient survival.Conclusions.Moreover, a preoperative elevated CA 19-9 proved to be a significant prognostic factor.

View Article: PubMed Central - PubMed

Affiliation: Department of General, Visceral, and Transplantation Surgery, Charité Campus Virchow Universitätsmedizin Berlin, 13353 Berlin, Germany.

ABSTRACT
Introduction. Although ampullary carcinoma has the best prognosis among all periampullary carcinomas, its long-term survival remains low. Prognostic factors are only available for a period of 10 years after pancreaticoduodenectomy. The aim of this retrospective study was to identify factors that influence the long-term patient survival over a 15-year observation period. Methods. From 1992 to 2007, 143 patients with ampullary carcinoma underwent pancreatic resection. 86 patients underwent pylorus-preserving pancreaticoduodenectomy (60%) and 57 patients underwent standard Kausch-Whipple pancreaticoduodenectomy (40%). Results. The overall 1-, 5-, 10-, and 15-year survival rates were 79%, 40%, 24%, and 10%, respectively. Within a mean observation period of 30 (0-205) months, 100 (69%) patients died. Survival analysis showed that positive lymph node involvement (P = 0.001), lymphatic vessel invasion (P = 0.0001), intraoperative administration of packed red blood cells (P = 0.03), an elevated CA 19-9 (P = 0.03), jaundice (P = 0.04), and an impaired patient condition (P = 0.01) are strong negative predictors for a reduced patient survival. Conclusions. Patients with ampullary carcinoma have distinctly better long-term survival than patients with pancreatic adenocarcinoma. Long-term survival depends strongly on lymphatic nodal and vessel involvement. Moreover, a preoperative elevated CA 19-9 proved to be a significant prognostic factor. Adjuvant therapy may be essential in patients with this risk constellation.

No MeSH data available.


Related in: MedlinePlus

The overall survival for patients after the resection of ampullary carcinoma with curative intention.
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Related In: Results  -  Collection


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fig1: The overall survival for patients after the resection of ampullary carcinoma with curative intention.

Mentions: After 1-, 5-, 10-, and 15-year periods, the overall survival of the examined patient population was 79%, 40%, 25%, and 10%, respectively, with a median survival term of 37 months (Figure 1). Survival analysis (log-rank) resulted in a significantly reduced survival for patients who had a reduced general condition (P = 0.008), required intraoperative administration of PRBC (P = 0.003), had POPF (P = 0.013), had an advanced tumor stage (P = 0.0001) (Figure 2), had a pT4 tumor invasion depth (P = 0.0001), had a positive lymph node stage (0.0001) (Figure 3), had a pG4 tumor grade (P = 0.0001), had a microscopically or macroscopically positive resection margin (P = 0.02) (Figure 4), had vascular (P = 0.008) or lymphatic invasion (P = 0.0001) (Figure 5), and had a preoperatively elevated CA 19-9 (P = 0.008). There were no significant differences in regard of overall survival in patients who received a PPPD and patients who underwent classic Whipple procedure (P = 0.222). A tumor size smaller than 2 cm did not have a significant effect on overall survival (P = 0.458). Examining the risk factors with respect to survival, multivariate analysis revealed that the following are risk factors for poor prognosis: lymphatic invasion (P = 0.000), intraoperative administration of PRBC (P = 0.008), and a preoperatively elevated CA 19-9 (P = 0.023) (Table 3).


Prognostic factors for long-term survival in patients with ampullary carcinoma: the results of a 15-year observation period after pancreaticoduodenectomy.

Klein F, Jacob D, Bahra M, Pelzer U, Puhl G, Krannich A, Andreou A, Gül S, Guckelberger O - HPB Surg (2014)

The overall survival for patients after the resection of ampullary carcinoma with curative intention.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3958923&req=5

fig1: The overall survival for patients after the resection of ampullary carcinoma with curative intention.
Mentions: After 1-, 5-, 10-, and 15-year periods, the overall survival of the examined patient population was 79%, 40%, 25%, and 10%, respectively, with a median survival term of 37 months (Figure 1). Survival analysis (log-rank) resulted in a significantly reduced survival for patients who had a reduced general condition (P = 0.008), required intraoperative administration of PRBC (P = 0.003), had POPF (P = 0.013), had an advanced tumor stage (P = 0.0001) (Figure 2), had a pT4 tumor invasion depth (P = 0.0001), had a positive lymph node stage (0.0001) (Figure 3), had a pG4 tumor grade (P = 0.0001), had a microscopically or macroscopically positive resection margin (P = 0.02) (Figure 4), had vascular (P = 0.008) or lymphatic invasion (P = 0.0001) (Figure 5), and had a preoperatively elevated CA 19-9 (P = 0.008). There were no significant differences in regard of overall survival in patients who received a PPPD and patients who underwent classic Whipple procedure (P = 0.222). A tumor size smaller than 2 cm did not have a significant effect on overall survival (P = 0.458). Examining the risk factors with respect to survival, multivariate analysis revealed that the following are risk factors for poor prognosis: lymphatic invasion (P = 0.000), intraoperative administration of PRBC (P = 0.008), and a preoperatively elevated CA 19-9 (P = 0.023) (Table 3).

Bottom Line: Survival analysis showed that positive lymph node involvement (P = 0.001), lymphatic vessel invasion (P = 0.0001), intraoperative administration of packed red blood cells (P = 0.03), an elevated CA 19-9 (P = 0.03), jaundice (P = 0.04), and an impaired patient condition (P = 0.01) are strong negative predictors for a reduced patient survival.Conclusions.Moreover, a preoperative elevated CA 19-9 proved to be a significant prognostic factor.

View Article: PubMed Central - PubMed

Affiliation: Department of General, Visceral, and Transplantation Surgery, Charité Campus Virchow Universitätsmedizin Berlin, 13353 Berlin, Germany.

ABSTRACT
Introduction. Although ampullary carcinoma has the best prognosis among all periampullary carcinomas, its long-term survival remains low. Prognostic factors are only available for a period of 10 years after pancreaticoduodenectomy. The aim of this retrospective study was to identify factors that influence the long-term patient survival over a 15-year observation period. Methods. From 1992 to 2007, 143 patients with ampullary carcinoma underwent pancreatic resection. 86 patients underwent pylorus-preserving pancreaticoduodenectomy (60%) and 57 patients underwent standard Kausch-Whipple pancreaticoduodenectomy (40%). Results. The overall 1-, 5-, 10-, and 15-year survival rates were 79%, 40%, 24%, and 10%, respectively. Within a mean observation period of 30 (0-205) months, 100 (69%) patients died. Survival analysis showed that positive lymph node involvement (P = 0.001), lymphatic vessel invasion (P = 0.0001), intraoperative administration of packed red blood cells (P = 0.03), an elevated CA 19-9 (P = 0.03), jaundice (P = 0.04), and an impaired patient condition (P = 0.01) are strong negative predictors for a reduced patient survival. Conclusions. Patients with ampullary carcinoma have distinctly better long-term survival than patients with pancreatic adenocarcinoma. Long-term survival depends strongly on lymphatic nodal and vessel involvement. Moreover, a preoperative elevated CA 19-9 proved to be a significant prognostic factor. Adjuvant therapy may be essential in patients with this risk constellation.

No MeSH data available.


Related in: MedlinePlus