Retrospective Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Oct 21, 2024; 30(39): 4281-4294
Published online Oct 21, 2024. doi: 10.3748/wjg.v30.i39.4281
Comparison of clinical characteristics and prognostic factors in two site-specific categories of ampullary cancer
Jing-Zhao Zhang, Zhi-Wei Zhang, Xin-Yi Guo, Deng-Sheng Zhu, Xiao-Rui Huang, Ming Cai, Tong Guo, Ya-Hong Yu
Jing-Zhao Zhang, Zhi-Wei Zhang, Xin-Yi Guo, Deng-Sheng Zhu, Xiao-Rui Huang, Ming Cai, Tong Guo, Ya-Hong Yu, Department of Biliopancreatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430000, Hubei Province, China
Co-first authors: Jing-Zhao Zhang and Zhi-Wei Zhang.
Co-corresponding authors: Tong Guo and Ya-Hong Yu.
Author contributions: Zhang JZ and Zhang ZW have contributed equally to this work; Zhang JZ was responsible for to data curation, conceptualization, methodology, and writing the original draft; Zhang ZW wrote the original draft and performed formal data analysis; Guo XY and Zhu DS completed case collection, follow-up and preliminary data compilation; Huang XR revised the manuscript and provided clinical advice. Guo T and Yu YH were contributed equally to supervision, funding acquisition, writing-review and editing. First, the corresponding author, as the primary individual responsible for the article, oversees the selection of the topic, research design, and content review. Both Professor Yu YH and Dr Guo T shared these responsibilities throughout the study's implementation. They jointly agreed on the topic selection, collaboratively formulated the research plan, and provided equally significant support in executing the plan. Second, upon completion of the manuscript, both authors contributed unique insights regarding the depth of the content and the rigor of the conclusions. They collaboratively assisted in the correction and editing processes and finalized the preparation of the relevant submission materials. Their contributions were equivalent in importance. Third, during the ethical review of this article, both authors jointly prepared the necessary materials, demonstrating the ethical soundness of this study, which successfully passed the ethical approval process. This collaboration ensured the smooth progression of the research. Fourth, both authors provided equally crucial assistance in securing funding for this study. Given the substantial contributions made by both individuals to this article, they are designated as co-corresponding authors.
Institutional review board statement: The study was approved by the ethics committee of the Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology.
Informed consent statement: The acquisition and use of these clinical data were approved by the Institutional Review Board. After review by the ethics committee, a waiver of informed consent was granted for this subject.
Conflict-of-interest statement: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Data sharing statement: The data that support the findings of this study are available from the corresponding author upon reasonable request.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ya-Hong Yu, MD, Professor, Department of Biliopancreatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095 Jie Fang Avenue, Wuhan 430000, Hubei Province, China. yuyahong615@sina.com
Received: May 9, 2024
Revised: September 13, 2024
Accepted: September 20, 2024
Published online: October 21, 2024
Processing time: 155 Days and 13.1 Hours
Abstract
BACKGROUND

Ampullary cancer is a relatively rare malignant tumor in the digestive system. Its incidence has increased in recent years. As for now, its biological characteristics have not been fully clarified. Recent studies have primarily focused on the histological classification and genetic changes, but there are fewer investigations into the differences among site-specific subgroups. The clinicopathological characteristics of ampullary cancer occurring in different positions have not been elucidated. Furthermore, the role of adjuvant therapy in the treatment of patients with ampullary cancer remains controversial.

AIM

To study the clinicopathological features of the two site-specific subgroups of ampullary cancer and explore the factors affecting prognosis.

METHODS

A total of 356 patients who met the inclusion and exclusion criteria were enrolled. Patients were divided into ampulla of Vater cancer (AVC) and duodenal papilla cancer (DPC) based on the gross and microscopic findings. Baseline data, admission examination results, and perioperative outcomes were collected and analyzed. The Kaplan-Meier curve was used for survival analysis. Univariate and multivariate analysis was performed to explore the independent risk factors affecting the overall survival (OS) of both groups.

RESULTS

The preoperative total bilirubin level in patients with AVC was significantly higher than those with DPC (P = 0.04). The OS for patients with DPC was 58.90 ± 38.74 months, significantly longer than 44.31 ± 35.90 months for patients with AVC (P < 0.01). The independent risk factors affecting the OS of AVC included: Preoperative albumin level (P = 0.009), total bilirubin level (P = 0.017), and number of positive lymph nodes (P = 0.005). For DPC, risk factors included: Age (P = 0.004), tumor size (P = 0.023), number of positive lymph nodes (P = 0.010) and adjuvant treatment (P = 0.020). Adjuvant therapy significantly improved the OS rate of patients with DPC, but not for those with AVC.

CONCLUSION

Patients with AVC had a shorter OS compared to those with DPC. The prognosis factors and the role of adjuvant therapy of two groups were different.

Keywords: Ampullary cancer; Prognosis; Risk factors; Overall survival; Adjuvant therapy

Core Tip: Ampullary cancer research is crucial due to its increasing incidence. This study differentiates ampullary cancer types based on its primary site, showing that ampulla of Vater cancer (AVC) patients have shorter overall survival than duodenal papilla cancer (DPC) patients. Prognosis for AVC may be affected by serum albumin, total bilirubin, and positive lymph nodes. For DPC patients, age, tumor size, and lymph node positivity are linked to worse outcomes, with adjuvant therapy potentially improving prognosis. The findings offer doctors valuable insights for managing both cancer types.