Outcomes of Palliative Chemotherapy for Ampulla of Vater Adenocarcinoma: A Multicenter Cohort Study.

Publisher: Editorial Office of Gut and Liver Country of Publication: Korea (South) NLM ID: 101316452 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 2005-1212 (Electronic) Linking ISSN: 19762283 NLM ISO Abbreviation: Gut Liver Subsets: MEDLINE

Original Publication: Seoul : Editorial Office of Gut and Liver

Ampulla of Vater*/pathology ; Palliative Care*/methods ; Adenocarcinoma*/drug therapy ; Adenocarcinoma*/mortality ; Adenocarcinoma*/pathology ; Common Bile Duct Neoplasms*/drug therapy ; Common Bile Duct Neoplasms*/mortality ; Common Bile Duct Neoplasms*/pathology ; Deoxycytidine*/analogs & derivatives ; Deoxycytidine*/administration & dosage ; Deoxycytidine*/therapeutic use ; Antineoplastic Combined Chemotherapy Protocols*/therapeutic use ; Gemcitabine* ; Oxaliplatin*/therapeutic use ; Oxaliplatin*/administration & dosage; Humans ; Male ; Middle Aged ; Female ; Retrospective Studies ; Aged ; Cisplatin/administration & dosage ; Cisplatin/therapeutic use ; Capecitabine/administration & dosage ; Capecitabine/therapeutic use ; Treatment Outcome ; Progression-Free Survival

Background/aims: : Palliative chemotherapy (PC) is not standardized for patients with advanced ampulla of Vater adenocarcinoma (AA). This multicenter, retrospective study evaluated first-line PC outcomes in patients with AA.
Methods: : Patients diagnosed with AA between January 2010 and December 2020 who underwent PC were enrolled from 10 institutions. Overall survival (OS) and progression-free survival (PFS) according to the chemotherapy regimen were analyzed.
Results: : Of 255 patients (mean age, 64.0±10.0 years; male, 57.6%), 14 (5.5%) had locally advanced AA and 241 (94.5%) had metastatic AA. Gemcitabine plus cisplatin (GP) was administered as first-line chemotherapy to 192 patients (75.3%), whereas capecitabine plus oxaliplatin (CAPOX) was administered to 39 patients (15.3%). The median OS of all patients was 19.8 months (95% confidence interval [CI], 17.3 to 22.3), and that of patients who received GP and CAPOX was 20.4 months (95% CI, 17.2 to 23.6) and 16.0 months (95% CI, 11.2 to 20.7), respectively. The median PFS of GP and CAPOX patients were 8.4 months (95% CI, 7.1 to 9.7) and 5.1 months (95% CI, 2.5 to 7.8), respectively. PC for AA demonstrated improved median outcomes in both OS and PFS compared to conventional bile duct cancers that included AA.
Conclusions: : While previous studies have shown mixed prognostic outcomes when AA was analyzed together with other biliary tract cancers, our study unveils a distinct clinical prognosis specific to AA on a large scale with systemic anticancer therapy. These findings suggest that AA is a distinct type of tumor, different from other biliary tract cancers, and AA itself could be expected to have a favorable response to PC.

Comment in: Gut Liver. 2024 Jul 15;18(4):560-561. doi: 10.5009/gnl240283. (PMID: 39005199)

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Keywords: Ampulla of Vater; Biliary tract neoplasms; Chemotherapy; Survival

0W860991D6 (Deoxycytidine)
0 (Gemcitabine)
04ZR38536J (Oxaliplatin)
Q20Q21Q62J (Cisplatin)
6804DJ8Z9U (Capecitabine)

Date Created: 20231222 Date Completed: 20240715 Latest Revision: 20241108

20250114

PMC11249934

10.5009/gnl230164

38130162