Patterns and Predictors of Failure after Curative Resections of Carcinoma of the Ampulla of Vater View Full Text


Ontology type: schema:ScholarlyArticle     


Article Info

DATE

2003-01

AUTHORS

Takeshi Todoroki, Naoto Koike, Yukio Morishita, Toru Kawamoto, Nobuhiro Ohkohchi, Junichi Shoda, Yoshiharu Fukuda, Hideto Takahashi

ABSTRACT

BACKGROUND: Curative resection does not always equate with long-term survival. The aim was to identify patterns and predictors of failure and independent factors of prognosis after curative resection. METHODS: Sixty-six patients with ampullary carcinoma who underwent surgical intervention were reviewed. Fifty-nine patients underwent pancreaticoduodenectomy. Cox regression analysis, log-rank test, Fisher exact test, or chi(2) test was used. RESULTS: No patient died as a result of surgery; major complications occurred in three, and the 5-year survival rate after curative resection (n = 55) was 52.6%. Significant survival predictors were preoperative serum carcinoembryonic antigen level; gross tumor appearance; tumor, node, and tumor node metastasis stage; and microscopic lymphatic vessel and venous invasion in the primary tumor. Multivariate analysis demonstrated that lymphatic vessel invasion, tumor, and tumor node metastasis stage were significant independent prognostic factors. No patient experienced locoregional failure alone; all 24 relapsed patients had distant failure, and six of them had both. The liver was the most frequent metastatic organ, followed by nodes, peritoneum, lung, and bone. The carcinoembryonic antigen and carbohydrate antigen levels and lymphatic vessel and venous invasion were significant predictors of distant failure, and the mean time to relapse was 13 (range, 0.7-33) months. CONCLUSIONS: Curative resection is associated with significant survival; however, effective systemic adjuvant therapy is needed to prevent distant failure for patients with elevated carcinoembryonic antigen and carbohydrate antigen levels or positive lymphatic vessel or venous invasion. A 3-year follow-up period would be necessary to document relapses. More... »

PAGES

1176-1183

Identifiers

URI

http://scigraph.springernature.com/pub.10.1245/aso.2003.07.512

DOI

http://dx.doi.org/10.1245/aso.2003.07.512

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1018610884

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/14654474


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33 schema:description BACKGROUND: Curative resection does not always equate with long-term survival. The aim was to identify patterns and predictors of failure and independent factors of prognosis after curative resection. METHODS: Sixty-six patients with ampullary carcinoma who underwent surgical intervention were reviewed. Fifty-nine patients underwent pancreaticoduodenectomy. Cox regression analysis, log-rank test, Fisher exact test, or chi(2) test was used. RESULTS: No patient died as a result of surgery; major complications occurred in three, and the 5-year survival rate after curative resection (n = 55) was 52.6%. Significant survival predictors were preoperative serum carcinoembryonic antigen level; gross tumor appearance; tumor, node, and tumor node metastasis stage; and microscopic lymphatic vessel and venous invasion in the primary tumor. Multivariate analysis demonstrated that lymphatic vessel invasion, tumor, and tumor node metastasis stage were significant independent prognostic factors. No patient experienced locoregional failure alone; all 24 relapsed patients had distant failure, and six of them had both. The liver was the most frequent metastatic organ, followed by nodes, peritoneum, lung, and bone. The carcinoembryonic antigen and carbohydrate antigen levels and lymphatic vessel and venous invasion were significant predictors of distant failure, and the mean time to relapse was 13 (range, 0.7-33) months. CONCLUSIONS: Curative resection is associated with significant survival; however, effective systemic adjuvant therapy is needed to prevent distant failure for patients with elevated carcinoembryonic antigen and carbohydrate antigen levels or positive lymphatic vessel or venous invasion. A 3-year follow-up period would be necessary to document relapses.
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39 schema:keywords Fisher's exact test
40 Vater
41 adjuvant therapy
42 aim
43 ampulla
44 ampulla of Vater
45 ampullary carcinoma
46 analysis
47 antigen
48 antigen levels
49 appearance
50 bone
51 carcinoembryonic antigen
52 carcinoembryonic antigen level
53 carcinoma
54 complications
55 curative resection
56 distant failure
57 effective systemic adjuvant therapy
58 elevated carcinoembryonic antigen
59 exact test
60 factors
61 failure
62 follow
63 gross tumor appearance
64 independent factors
65 independent prognostic factor
66 intervention
67 invasion
68 levels
69 liver
70 locoregional failure
71 log-rank test
72 long-term survival
73 lung
74 lymphatic vessel invasion
75 lymphatic vessels
76 major complications
77 mean time
78 metastasis stage
79 metastatic organs
80 months
81 multivariate analysis
82 node metastasis stage
83 nodes
84 organs
85 pancreaticoduodenectomy
86 patients
87 patterns
88 period
89 peritoneum
90 positive lymphatic vessels
91 predictors
92 predictors of failure
93 preoperative serum carcinoembryonic antigen level
94 primary tumor
95 prognosis
96 prognostic factors
97 rate
98 regression analysis
99 relapse
100 resection
101 results
102 results of surgery
103 serum carcinoembryonic antigen level
104 significant independent prognostic factor
105 significant predictors
106 significant survival
107 significant survival predictors
108 stage
109 surgery
110 surgical intervention
111 survival
112 survival predictors
113 survival rate
114 systemic adjuvant therapy
115 test
116 therapy
117 time
118 tumor appearance
119 tumor node metastasis stage
120 tumors
121 venous invasion
122 vessel invasion
123 vessels
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