[728] Duodenal Carcinomas of Non-Ampullary Origin Are Significantly More Aggressive Than Ampullary Carcinomas

Burcu Saka, Pelin Bagci, Alyssa Krasinskas, Olca Basturk, Takuma Tajiri, Nobuyuki Ohike, Grace E Kim, Serdar Balci, Kee-Taek Jang, Sudeshna Bandyopadhyay, David Kooby, Shishir K Maithel, Juan Sarmiento, Charles Staley, Denizhan Ozdemir, So Yeon Kong, Alton B Farris, Volkan Adsay. Emory University, Atlanta, GA; UPMC, Pittsburgh, PA; Memorial Sloan-Kettering Cancer Center, New York, NY; TUHH, Tokyo, Japan; SU, Tokyo, Japan; UCSF, San Francisco, CA; SMC, Seoul, Korea; Wayne State University, Detroit, MI

Background: The information on duodenal carcinomas is fairly limited and those arising from non-ampullary duodenum are largely uncharacterized.
Design: 43 resected duodenal carcinomas that spared the ampulla were identified, and their clinicopathologic characteristics were contrasted with those of 298 ampullary and 295 pancreatic ca.
Results: See Table for clinicopathologic comparison. Other findings: Many showed ulcerating-plaque like growth; only 15 had identifiable adenoma component. Predominant pattern was pancreatobiliary(PB) in 22, intestinal-16, poorly diff-4 (2-medullary,1-hepatoid), and mucinous-1. Other patterns encountered were squamous-4, oncocytic-1, and foveolar gland like-1. 3 had foci of distinctive and previously uncharacterized microcystic pattern.

Characteristics†Ampullary (n = 298)Pancreas (n = 295)Duodenal (n = 43)p-value‡
Age (±SD)65.0 (11.8)63.7 (11.2)62.3 (14.7)0.1995
Gender
Female120 (40%)156 (53%)19 (44%)0.0073
Male178 (60%)138 (47%)24 (56%)
Overall Size, cm (range)2.6 (0.3 - 8.0)3.3 (0.7 -11.0)3.7 (0.1- 8.0)<0.0001
Size of Invasion, cm (range)1.9 (0.2 -6.0)3.2 (0.7 - 11.0)3.1 (0.1 -8.0)<0.0001
<1 cm52 (18%)1 (0.4%)5 (12%)<0.0001
≥1 cm246 (83%)272 (100%)38 (88%)
LN Status
LN Positive119 (42%)177 (65%)22 (58%)<0.0001
LN Negative163 (58%)95 (35%)16 (42%)
Margin Positivity Rate
R0282 (96%)175 (66%)25 (96%)<0.0001
R113 (4%)89 (34%)1 (4%)
R202 (0.7%)0
Perineural Invasion79 (27%)158 (87%)16 (40%)<0.0001
Vascular Invasion187 (63%)84 (55%)31 (76%)0.0429
Tumor Stage
T170 (24%)13 (8%)6 (14.%)<0.0001
T2105 (36%)66 (39%)5 (12%)
T398 (33%)85 (50%)21 (49%)
T422 (8%)5 (3%)11 (26%)
Survival Rates
1-year81%53%65%<0.0001
3-year57%21%45%
5-year42%12%25%
†Subjects with missing values were excluded for each characteristic variable. ‡Based on t-test for continuous variables, Fisher´s chi square test or exact test (if n<5) for categorical variables, and log-rank test for survival rates.


Conclusions: Non-ampullary duodenal cancers present with more advanced tumors than ampullary (larger overall and inv size, and higher incidence of LN mets, R1 rate, perineural-vascular inv), and have a significantly more aggressive clinical outcome.Morphologic patterns differ from lower-GI cancers with common plaque-like growth, predominant PB histology, and unusual patterns including a distinctive microcystic type and others.
Category: Gastrointestinal

Tuesday, March 5, 2013 1:00 PM

Poster Session IV # 113, Tuesday Afternoon

 

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