Características anatomopatológicas e sobrevida em 5 anos de pacientes com adenocarcinoma da ampola de Vater dos tipos intestinal e pancreatobiliar

Abstract

Adenocarcinomas of the Vater's ampulla (AAV) are rare tumors, but their incidence is increasing. Two histological subtypes have been described, intestinal (TI) and pancreatobiliary (TPB), with distinct prognoses. The characteristics that define them and their prognostic factors are the subject of numerous publications. Recently, the analysis of lymph node involvement has gained prominence as the main prognostic factor in this disease. The objective of this study was to identify the anatomopathological factors that impact survival, identifying the main anatomopathological characteristics of each histological subtype, analyzing lymph node involvement and the relationship of affected lymph nodes with the total number of dissected lymph nodes (RL), in order to identify their prognostic role and the best cutoff value for RL, and analyzing overall and disease-free survival at 5 years after treatment. Sixty-seven patients with AAV (34 TI and 33 TPB) who underwent duodenopancreatectomy with lymphadenectomy at a single center from 2003 to 2022 were studied and followed up for 5 years. Anatomopathological parameters and data on death and recurrence in the postoperative follow-up were prospectively collected and retrospectively analyzed. The chi-square, Fisher's exact, Mann Whitney, and t-Student tests were used to analyze the association between data and histological subtypes, as well as binary logistic regression. To analyze the best cutoff value for RL, as well as its sensitivity and specificity, the ROC curve and the Youden index were used. Kaplan-Meier curves were used to analyze overall and disease-free survival, compared by the Logrank test, applied to the Cox logistic regression model. Larger tumor size (p<0.001), advanced stage (p=0.005), low degree of differentiation (p=0.003), and the presence of angiolymphatic invasion (p<0.001) were related to TPB. In multivariate analysis, tumor size (p=0.02) and angiolymphatic invasion (p=0.002) remained significantly associated with TPB. The best cutoff point for RL was 0.154, with sensitivity and specificity for death of 80% and 97.8%, respectively. Overall and disease-free survival at 5 years were 75.4%. In the univariate analysis of 5-year overall and disease-free survivals, tumor size, lymph node status, RL, angiolymphatic and perineural invasions, tumor differentiation, and histology were statistically significant (p<0.05). RL≥0.154 remained the only independent poor prognostic factor in multivariate analysis (HR 24.9 95%CI 6.8-91 p<0.001 for overall survival and HR 25.71 95%CI 6.8-96.8 p<0.001 for disease-free survival). In conclusion, the pancreatobiliary subtype presented at more advanced stages and had a worse prognosis, with lower overall survival and higher rates of disease recurrence. RL≥0.154 was the only independent poor prognostic factor.