Clinicopathologic Comparison of Ampullary Versus Pancreatic Carcinoma: Preinvasive Component, Size of Invasion, Stage, Resectability and Histologic Phenotype Are the Factors for the Significantly Favorable Outcome of Ampullary Carcinoma
Burcu Saka, Takuma Tajiri, Nobuyuki Ohike, Pelin Bagci, Alyssa Krasinskas, Grace E Kim, Shishir K Maithel, Juan Sarmiento, David Kooby, Denizhan Ozdemir, Olca Basturk, Bassel El-Rayes, So Yeon Kong, Michael Goodman, Alton B Farris, Volkan Adsay. Emory University, Atlanta, GA; University of Pittsburgh, Pittsburgh, PA; UCSF, San Francisco, CA; Wayne State University, Detroit, MI
Background: The information on the clinical outcome differences of ampullary versus pancreatic carcinoma (AC vs PC) has been conflicting largely because of their poor definition and differential from each other, classified and analyzed together under the rubric of “periampullary cancers”.
Design: 292 stringently-defined ACs identified based on the refined criteria set forth recently (Am J Surg Pathol, 2012) were compared with 297 invasive PCs.
Results: Compared to PCs, ACs often presented with a significant mass-forming preinvasive component (tumoral intraepithelial neoplasm), smaller invasive carcinomas, less advance stage (lower incidence of lymph node metastasis), higher resectability, and less aggressive histologic phenotype (higher incidence of non-pancreatobiliary cases and less perineural invasion).
|Ampullary Cancer (n=292)||Pancreas Cancer (n=297)||p-value|
|Overall size (cm)||2.6 (0.3-8.0)||3.3 (0.7-11.0)||<0.0001|
|Size of invasion (cm)||1.9 (0.2-6.0)||3.2 (0.7-11.0)||<0.0001|
|Frequency of invasion size < 1.0 cm||52 (17%)||1 (0.4%)||<0.0001|
|Frequency of LN mets||119 (42%)||177 (65%)||<0.0001|
|Margin positivity rate||13 (4%)||91(34%)||<0.0001|
|Histologic type as Pancreatobiliary||139 (47%)||286 (97%)||<0.0001|
|Perineural invasion||79 (27%)||158 (86%)||<0.0001|
|Vascular invasion||187 (63%)||84 (55%)||0.105|