Prediction of tumor recurrence and poor survival of ampullary adenocarcinoma using preoperative clinical and CT findings

Abstract

Objectives To predict poor survival and tumor recurrence in patients with ampullary adenocarcinoma using preoperative clinical and CT findings. Materials and methods A total of 216 patients with ampullary adenocarcinoma who underwent preoperative CT and surgery were retrospectively included. CT was assessed by two radiologists. Clinical and histopathological characteristics including histologic subtypes were investigated. A Cox proportional hazard model and the Kaplan-Meier method were used to identify disease-free survival (DFS) and overall survival (OS). A nomogram was created based on the multivariate analysis. The optimal cutoff size of the tumor was evaluated and validated by internal cross validation. Results The median OS was 62.8 +/- 37.9, and the median DFS was 54.3 +/- 41.2 months. For OS, tumor size (hazard ratio [HR] 2.79,p < 0.001), papillary bulging (HR 0.63,p = 0.049), organ invasion on CT (HR 1.92,p = 0.04), male sex (HR 1.59,p = 0.046), elevated CA 19-9 (HR 1.92,p = 0.01), pT stage (HR 2.45,p = 0.001), and pN stage (HR 3.04,p < 0.001) were important predictors of survival. In terms of recurrence, tumor size (HR 2.37,p = 0.04), pT stage (HR 1.76,p = 0.03), pN stage (HR 2.23,p = 0.001), and histologic differentiation (HR 4.31,p = 0.008) were important predictors of recurrence. In terms of tumor size on CT, 2.65 cm and 3.15 cm were significant cutoff values for poor OS and RFS (p < 0.001). Conclusion Preoperative clinical and CT findings were useful to predict the outcomes of ampullary adenocarcinoma. In particular, tumor size, papillary bulging, organ invasion on CT, male sex, and elevated CA 19-9 were important predictors of poor survival after surgery.