59P - Prognostic score to predict recurrence after pancreaticoduodenectomy for ampullary carcinoma: Results from the French prospective FFCD cohort

Background

Ampullary carcinoma (AC) is a rare GI cancer. Disease recurrence rate is about 40% after curative-intent surgery. However, main prognostic factors and adjuvant treatment decision remain a matter of debate.

Methods

The FFCD cohort is a French nationwide prospective cohort, including patients with a resected non-metastatic AC or presenting a locoregional or metastatic disease recurrence within 2 years after tumor resection. The aim of this study is to describe prognostic factors associated with disease-free survival (DFS) after pancreaticoduodenectomy (PD) to propose a user-friendly score to better estimate the risk of recurrence and the benefit of adjuvant therapy.

Results

370 patients resected AC were included between July 2014 and June 2023 in 50 centers. Median age was 68.5, 199 (53.8%) patients were male and 180 (56.1%) had an ECOG-PS 0. Histological subtype was intestinal, pancreatobiliary or mixed/undetermined in 29/41/30% of patients. Adjuvant chemotherapy was performed in 226 (61.1%) patients. Median follow-up of the cohort was 40.6 months. In multivariable analyses, stage III tumor vs other (HR=2.86 [1.89 ;4.17], p<0.0001), poorly vs well differentiated grade (HR=2.51 [1.42;4.43], p=0.002) and non-intestinal vs intestinal subtype (HR=1.58 [1.00;2.49], p=0.052) were associated with shorter DFS. A score based on these 3 parameters divided patients in low (n=83), intermediate (n=133) and high risk (n=96) with a median DFS not reached (NR), 73.1 and 15.2 months and a median overall survival (OS) NR, 86.1 and 38.2 months. Adjuvant chemotherapy was associated with a longer DFS in high-risk (HR=0.37, p=0.001) and in intermediate risk (HR=0.77, p=0.369) while no benefit was observed in low-risk tumors. Finally, after propensity score analysis, adjuvant therapy was associated with longer DFS (HR=0.57, [0.45;0.72] p<0.0001) and OS (HR=0.57, [0.44;0.74], p<0.0001) in the full cohort.

Conclusions

Lymph node invasion, poorly differentiated grade and non-intestinal subtype seem highly prognostic in resected AC. This integrated score using these parameters needs to be confirmed in an external validation dataset to help adjuvant treatment decision making.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

Fédération Francophone de Cancérologie Digestive.

Funding

Fédération Francophone de Cancérologie Digestive.

Disclosure

G. Roth: Financial Interests, Personal, Advisory Board: Servier, AstraZeneca, MSD, BMS, Ipsen, Viatris; Financial Interests, Personal, Invited Speaker: Pierre Fabre; Financial Interests, Institutional, Coordinating PI: Genoscience Pharma; Financial Interests, Personal and Institutional, Coordinating PI: Netris pharma, Alpha Tau. A. Pellat: Financial Interests, Personal, Invited Speaker: Servier; Non-Financial Interests, Member, Academic group: Fondation Française de Cancérologie Digestive, Groupe des Tumeurs Neuroendocrines; Other, Invitation to ENETS: Ipsen. C. Gallois: Financial Interests, Institutional, Invited Speaker: Sanofi Genzyme; Financial Interests, Institutional, Advisory Board: Servier, Pierre Fabre, Merck; Financial Interests, Institutional, Other, French congress invitation: MSD; Financial Interests, Institutional, Other, Congress invitation: Amgen. D. Tougeron: Financial Interests, Personal, Advisory Board: AstraZeneca, Sanofi, Amgen, MSD, Roche, Servier, Pierre Fabre, BMS, Bayer; Non-Financial Interests, Member of Board of Directors: Federation Francophone de Cancérologie Digestive. V. Hautefeuille: Financial Interests, Personal, Invited Speaker: Novartis, Merck, Amgen; Financial Interests, Personal, Advisory Board: AAA, Ipsen, Pierre Fabre; Financial Interests, Institutional, Invited Speaker: Deciphera, Esteve. M. Jary: Financial Interests, Personal, Invited Speaker: Pierre Fabre, Servier, MSD, BMS, Amgen; Financial Interests, Personal, Writing Engagement: Incyte; Other, participation to congresses: Pierre Fabre; Other, Participation to congresses: Roche, Bayer; Other, Participation to Congress: Servier, MSD, BMS. M. Muller: Financial Interests, Institutional, Invited Speaker: Servier. O. Bouche: Financial Interests, Personal, Advisory Board: Amgen, Merck, Apmonia Therapeutics, Deciphera, Astellas, Takeda; Financial Interests, Personal, Invited Speaker: Servier, Pierre Fabre, Bayer. J. Taieb: Financial Interests, Personal, Advisory Board: MSD, Astellas, Merck, Servier, Pierre Fabre, Amgen, BMS, Novartis, Pfizer, Sanofi, Rottapharm, Takeda, Financial Interests, Personal, Invited Speaker: Amgen, BMS, Merck, MSD, Novartis; Financial Interests, Personal, Invited Speaker, symposia: Astellas; Financial Interests, Personal, Other, steering Committee of clinical trial: Novartis; Non-Financial Interests, Leadership Role, President of the scientific committee of the ARCAD foundation until end 2022: ARCAD Foundation; Non-Financial Interests, Leadership Role, Chair of the ARCAD pancreas research group: ARCAD Foundation; Non-Financial Interests, Leadership Role, Member of the administrative council, the scientific committee, the executive board and responsible for the international relationships /partnership for FFCD in the Prodige Intergroup: Federation Francophone de Cancérologie Digestive (FFCD); Non-Financial Interests, Other, steering committee of clinical trials: Pfizer, Servier. All other authors have declared no conflicts of interest.