Prospective Study
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World J Gastroenterol. Aug 7, 2014; 20(29): 10144-10150
Published online Aug 7, 2014. doi: 10.3748/wjg.v20.i29.10144
Trends in incidence and management of cancer of the ampulla of Vater
Florian Rostain, Samia Hamza, Antoine Drouillard, Jean Faivre, Anne-Marie Bouvier, Côme Lepage
Florian Rostain, Samia Hamza, Antoine Drouillard, Jean Faivre, Anne-Marie Bouvier, Côme Lepage, Registre Bourguignon des Cancers Digestifs, INSERM U866, CHU de Dijon, Faculté de Médecine, 21079 Dijon Cedex, France
Author contributions: Rostain F, Bouvier AM and Lepage C designed the research; Hamza S, Drouillard A and Faivre J contributed analytic tools; Rostain F and Bouvier AM analyzed the data; all authors contributed to the writing of the paper and approved the final version.
Correspondence to: Côme Lepage, Professor, Registre Bourguignon des Cancers Digestifs, INSERM U866, CHU de Dijon, Faculté de Médecine, BP 87900, 21079 Dijon Cedex, France. come.lepage@u-bourgogne.fr
Telephone: +33-3-80393340  Fax: +33-3-80668251
Received: September 13, 2013
Revised: February 11, 2014
Accepted: February 17, 2014
Published online: August 7, 2014
Abstract

AIM: To provide trends in incidence, management and survival of cancer of the ampulla of Vater in a well-defined French population.

METHODS: Data were obtained from the population-based digestive cancer registry of Burgundy over a 34-year period. Age-standardized incidence rates were computed using the world standard population. Average annual variations in incidence rates were estimated using a poisson regression. A univariate and multivariate relative survival analysis was performed.

RESULTS: Age-standardized incidence rates were 0.46 and 0.30 per 100000 inhabitants for men and women, respectively. Incidence rate increased from 0.26 (1976-1984) to 0.58 (2003-2009) for men and remained stable for women. Resection for cure was performed in 48.3% of cases. This proportion was stable over the study period. Among cases with curative resection, pancreatico-duodenectomy was performed in 94.0% of cases and ampullectomy in 6.0% of cases. A total of 50.8% of cancers of the ampulla of Vater were diagnosed at an advanced stage. Their proportion remained stable throughout the study period. The overall 1- and 5-year relative survival rates were 60.2% and 27.7%, respectively. Relative survival did not vary over time. Treatment and stage at diagnosis were the most important determinants of survival. The 5-year relative survival rate was 41.5% after resection for cure, 9.5% after palliative surgery and 6.7% after symptomatic treatment. In multivariate analysis, only stage at diagnosis significantly influenced the risk of death.

CONCLUSION: Cancer of the ampulla of Vater is still uncommon, but its incidence increased for men in Burgundy. Diagnosis is often made at an advanced stage, dramatically worsening the prognosis.

Keywords: Cancer of the ampulla of Vater, Incidence, Survival, Treatment, Epidemiology

Core tip: Cancer of the ampulla of Vater is still uncommon, but its incidence increased for men in Burgundy. Cancers were diagnosed at an advanced stage (distant metastasis and/or unresectable) in 50.8% of the cases. Resection for cure was performed in half of patients. The absence of improvement in stage at diagnosis and overall survival over time is disappointing. The overall 5-year relative survival rate was 27.7%, and did not vary over time. The 5-year relative survival rate was 41.5% after resection for cure, 9.5% after palliative surgery and 6.7% after symptomatic treatment. In multivariate analysis, only stage at diagnosis significantly influenced the risk of death.