Background:
The aim of this study is to assess the patterns of recurrence in patients with clinical stage I-III ampullary carcinoma (AMPAC) as compared to distal bile duct carcinoma (DBDC) after curative-intent surgical resection.
Methods:
Patients with histologically DBDC and AMPAC in clinical stage I-III were extracted from the nationwide registry by the German Cancer Registry Group of the Society of German Tumor Centers – Network of Care, Quality and Research in Oncology (GCRG/ADT). Statistical testing was performed using SPSS 25.
Results:
A total of 31,483 patients were identified from the GCRG/ADT in the period from 2000-2021. 4,742 patients had AMPAC while 26,741 patients had DBDC. The rate of local recurrence was comparable for AMPAC and DBDC patients (9.0% vs. 9.8%, p=0.094) while distant metastasis was more frequent in DBDC patients (25.1% vs. 31.8%, p=0.001). AMPAC patients had prolonged disease-free survival (45.0m vs. 39.8m, p<0.001) as well as prolonged overall survival (84.1 m vs. 81.9 m, p<0.001). While time to local recurrence was comparable for AMPAC and DBDC (84.6m vs. 89.5m, p=0.114), disease-free survival was improved in patients with AMPAC (45.0m vs. 39.8m, p=0.001).
AMPAC and DBDC patients with distant metastasis as compared to those with local recurrence were more likely to have surrogate parameters of loco-regional invasion such as advanced T and N stage, LNR, and lymphovascular and perineural invasion. Adjuvant therapy was rare in AMPAC (10.6%) as well as DBDC (25.6%) and comparable in those with local and distant recurrence.
Conclusion:
While rates of and time to local recurrence are comparable for both entities, distant recurrence is more frequent and occurs earlier in DBDC. Distant recurrence is associated with surrogate parameters of loco-regional invasion in both entities.
