@article{Ma2025, 
author = {Xiaoqing Ma and Chenyang Meng and Xuejing Shi and Zhaoyu Zhang and Qiuli Li and Hongwei Wang and Yuexiang Liang and Song Gao and Xiuchao Wang and Chuntao Gao and Jian Wang and Weidong Ma and Yukuan Feng and Shuo Li and Xingyun Chen and Wei Li and Shangheng Shi and Tianxing Zhou and Jun Yu and Jihui Hao},
title = {Identifying occult high-risk features and stratified management strategies following curative resection for ampullary adenocarcinoma},
year = {2025},
journal = {Cancer Biology & Medicine},
volume = {22},
number = {10},
pages = {1255-1266},
keywords = {prognostic factors, Adjuvant chemotherapy, pancreaticoduodenectomy, ampullary adenocarcinoma, tumor deposits, vascular invasion},
url = {https://www.sciopen.com/article/10.20892/j.issn.2095-3941.2025.0181},
doi = {10.20892/j.issn.2095-3941.2025.0181},
abstract = {ObjectiveThe aim of the current study was to identify independent prognostic factors, evaluate differential adjuvant chemotherapy efficacy across clinicopathologic subgroups, and define adjuvant chemotherapy-sensitive populations.MethodsA retrospective analysis of 168 AAC patients undergoing curative pancreaticoduodenectomy (2011–2020) was performed. Cases were classified into intestinal (28.0%), pancreatobiliary (30.4%), and mixed subtypes (18.5%) per NCCN (v2.2025) criteria. Independent prognostic factors for AAC patients were identified through uni- and multi-variable Cox proportional hazards modeling and subgroup analyses were stratified by age range, gender, differentiation, T stage, N stage, BVI, TDs, and PNI.ResultsThe pancreatobiliary signature (HR = 2.884, P < 0.001) and BVI (HR = 2.330, P = 0.001) were independent poor prognostic factors. Adjuvant chemotherapy improved overall survival (OS) in the following AAC patients: T3–T4 stage (HR = 0.485, P = 0.050); N1–N2 stage (HR = 0.365, P = 0.008); and TD-positive (HR = 0.401, P = 0.026). The median OS increased from 22.3–51.3 months with adjuvant chemotherapy in TD-positive patients (P = 0.019). TD positivity conferred a worse prognosis in BVI-negative subgroups (OS: HR = 3.840, 95% CI: 2.058–7.166, P < 0.001; and progression-free survival (PFS): HR = 2.950, 95% CI: 1.550–5.617, P = 0.002).ConclusionsThe pancreatobiliary signature and BVI constitute critical high-risk pathologic features in AAC. TD status identified high-risk cohorts, thus enabling postoperative risk-stratified treatment strategies. In patients negative for pancreatobiliary signature or BVI, TD positivity predicted significantly worse survival.}
}