Abstracts
1998 Digestive Disease Week

#1028

CANCER OF THE PAPILLA (AMPULLA) OF VATER: CLINICO-PATHOLOGICAL AND MOLECULAR FACTORS INFLUENCING SURVIVAL AND TREATMENT. C Iacono1, A Scarpa2, G Zamboni2, G Verlato3, L Bortolasi1, A Baron2, G Serio1. Departments of Surgery1, Pathology2, and Medical Statistics3, University of Verona, ITALY.

Cancer of the papilla (ampulla) of Vater is the second most common periampullary malignancy. There are discordant data on the factors affecting prognosis, and therefore, the therapeutical choices. Aim. To evaluate whether a combination of clinicopathological and molecular factors may be useful to assess prognosis and choose the best treatment. Patients and Methods. Fifty-four pts undergoing pancreatico-duodenectomy (PD) for ampullary adeno-carcinomas (from 1970 to 1996) were studied for standard clinicopathological factors. Forty-four cases were also analyzed for molecular anomalies, including chromosome 17p and 18q allelic losses (LOH) and the occurrence of microsatellite instability of the type seen in replication error (RER)-phenotype cancers. Factors influencing outcome were evaluated by univariate and multivariate analysis. Results. The overall 5 and 10-year survival rates were 44% and 31%, respectively. Five and 10-year survivals were 69% and 51% for T-stage II, 50% and 37% for T-stage III, and 24% and 17% for T-stage IV. Chromosome 17p and 18q LOH were detected in 23 (52%) and 15 cases (34%), respectively, and in 12 cases coexisted. RER-phenotype was identified in 6 cases (14%). At univariate analysis, factors associated with poor survival were: ulceration of the cancer (p=0.01), poor differentiation (p=0.03), T-stage IV (p<0.001), chromosome 17p (p<0.001) and 18q LOH (p<0.001) and absence of mutator-phenotype (p<0.007). According to multivariate analysis, T-stage (RR of T-stage IV vs II=14.4, 95% CI: 3.0-70.1, p<0.001) and chromosome 17p LOH (RR of absence vs presence=0.14, 95% CI: 0.05-0.43, p<0.001) were independent predictors of survival. All patients with RER-phenotype cancers were long-survivors (even though the tumors were classified T-stage IV and/or N1), while 5 and 10-year survivals in the pts with RER-negative cancers were 31% and 27%, respectively Conclusion. Our data suggest that RER-phenotype and chromosome 17p status permit detection prognosis among ampullary cancers at the same stage, and that patients showing RER-phenotype cancer may require only PD for cure while patients showing allelic losses may require additional therapy (chemo-radiation) after surgery.

Copyright 1996 - 1998, SSAT, Inc. Revised 29 June 1998.