Elsevier

Pancreatology

Volume 17, Issue 2, March–April 2017, Pages 273-278
Pancreatology

The histopathologic type predicts survival of patients with ampullary carcinoma after resection: A meta-analysis

https://doi.org/10.1016/j.pan.2017.01.007Get rights and content

Abstract

Objectives

The results of studies on the prognostic value of histopathologic differentiation of the intestinal and pancreatobiliary types of ampullary carcinoma after resection are conflicting. A meta-analysis was undertaken to investigate this issue.

Methods

A systematic literature search was performed to identify articles published from January 2000 to August 2016. Data were pooled for meta-analysis using Review Manager 5.3.

Results

Twenty three retrospective studies involving a total of 2234 patients were identified for inclusion, of whom 1021 (45.7%) had intestinal type tumors and 899 (40.2%) had pancreaticobiliary type tumors. Patients with the pancreaticobiliary type had high rates of poor tumor differentiation (P < 0.001), lymph node metastasis (P < 0.001), vascular invasion (P < 0.001), perineural invasion (P < 0.001), and positive resection margins (P = 0.004), as compared with those with the intestinal type. The pancreaticobiliary type predicted a worse overall survival (hazard ratio [HR] 1.84, 95% CI 1.49–2.27; P < 0.001) and disease-free survival (HR 1.93, 95% CI 1.23–3.01; P = 0.004).

Conclusion

The histopathologic type has major impact on survival in patients with ampullary carcinoma after resection, and the pancreaticobiliary type reflects a more aggressive tumor biology and is associated with worse survival.

Introduction

Periampullary carcinoma may originate from the mucosa of the ampulla of Vater, the pancreatic duct, the distal common bile duct, or the duodenum. Carcinoma of the ampulla of Vater is a relatively rare neoplasm, accounting for approximately 0.2% of gastrointestinal malignancies or 7% of periampullary carcinomas [1]. Although patients with ampullary carcinoma have a more favorable prognosis than those with other periampullary malignancies, a subset of these patients eventually succumb to the disease after resection. Identification of predictors associated with poor prognosis would help stratify patients for appropriate management categories. Ampullary carcinomas can be classified histologically into two main subgroups: intestinal type and pancreatobiliary type [2]. In tumorigenesis, the former type arises from the intestinal mucosa of the papilla and evolves through an adenoma-carcinoma sequence, and the latter type originates from the epithelium of the common ampullary channel, the distal pancreatic duct, or the distal common bile duct and evolves from precursor large-duct pancreatic intraepithelial neoplasia [3]. Many studies have tried to determine whether or not this classification has a prognostic value. However, the study results are often conflicting or inconclusive mainly because of the relatively small sample sizes [4], [5], [6], [7], [8], [9], [10], [11], [12], [13]. To increase the statistical power and allow reliable assessment of data available in published studies, this meta-analysis was undertaken to compare the clinicopathologic characteristics and long-term survival for intestinal-type and pancreatobiliary-type of ampullary carcinoma after resection.

Section snippets

Study selection

The present study was performed by following the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement [14]. Medline and EMBASE databases from January 2000 to August 2016 were searched by using the following Mesh search headings: “ampulla of Vater,” “carcinoma,” and “cancer.” The reference lists of all retrieved articles were manually reviewed in order to identify additional studies.

Criteria for inclusion and exclusion

To be eligible for inclusion, a study needed to report on

Selection of studies

Of the 2384 publications retrieved from the initial search, 23 retrospective studies involving a total of 2234 patients were identified for inclusion (Fig. 1). The main characteristics of the 23 studies [4], [5], [6], [7], [8], [9], [10], [11], [12], [13], [16], [17], [18], [19], [20], [21], [22], [23], [24], [25], [26], [27], [28], [29] are summarized in Table 1. Histologically, 1021 (45.7%) cases were classified as intestinal type, 899 (40.2%) as pancreatobiliary type, and 147 (6.6%) as other

Discussion

Since 1994 when Kimura et al. [2] first classified ampullary carcinomas into the intestinal type and the pancreaticobiliary type histologically, its potential impact on the prognosis has become a focus of research. Some studies [4], [5], [7], [9] reported that survival of patients with the pancreaticobiliary type was lower than that of patients with the intestinal type, while others [6], [10], [11] failed to find a significant difference. However, due to the low incidence of this disease, most

Conclusion

In conclusion, the present study has demonstrated that the histopathologic type has major impact on survival of patients with ampullary carcinomas after resection and may be helpful in selecting patients for optimal therapies.

Conflicts of interest

The authors declare no potential competing interests. The authors received no funding for this work.

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