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Hepato-pancreato-biliary

E218: Genomic Classification of Ampullary Adenocarcinoma to Guide Adjuvant Treatment Selection

    ePoster Abstract Author(s)

  • Brett L. Ecker, MD

    Assistant Professor of Surgery
    Rutgers Cancer Institute of New Jersey - Rutgers Robert Wood Johnson Medical School, United States

    • Submitter(s)

  • Brett L. Ecker, MD

    Assistant Professor of Surgery
    Rutgers Cancer Institute of New Jersey - Rutgers Robert Wood Johnson Medical School, United States

    • Author(s)

  • Brett L. Ecker, MD

    Assistant Professor of Surgery
    Rutgers Cancer Institute of New Jersey - Rutgers Robert Wood Johnson Medical School, United States

  • KS

    Kenneth Seier, MS

    Biostatistician
    Memorial Sloan Kettering, United States

  • AC

    Ankur Choubey, MD

    Research Fellow
    MSKCC, United States

  • Austin M. Eckhoff, MD

    General Surgery Resident
    Duke University Medical Center
    Durham, North Carolina, United States

  • WF

    William Fisher, MD

    Professor
    Baylor College of Medicine, Department of Surgery, United States

  • MG

    Marie-Claude Gingras, PhD

    Professor
    Baylor, United States

  • Michael E. Lidsky, MD

    Associate Professor of Surgery
    Duke University Medical Center
    Durham, North Carolina, United States

  • Michael J. Overman, MD

    Professor
    MD Anderson Cancer Center
    Houston, Texas, United States

  • RR

    Robert Roses, MD

    Associate Professor of Surgery
    Hospital of University of Pennsylvania, United States

  • CS

    Carlie Sigel, MD

    Associate Attending
    Memorial Sloan Kettering Cancer Center, United States

  • Gabriella N. Tortorello, MD

    Resident
    Hospital of the University of Pennsylvania
    Philadelphia, Pennsylvania, United States

  • CV

    Charles Vollmer, MD

    Chief, Division of Gastrointestinal Surgery at Penn Medicine
    Hospital of University of Pennsylvania, United States

  • MG

    Mithat Gonen, PhD

    Chief of Epidemiology and Biostatistics
    Memorial Sloan Kettering Cancer Center, United States

  • WJ

    William R. R. Jarnagin, MD

    Chief of Hepatopancreatobiliary Surgery
    Memorial Sloan Kettering Cancer Center, United States

Introduction: Ampullary adenocarcinoma is a heterogeneous disease with an unclear benefit of adjuvant chemotherapy. A previously developed and externally validated genomic classifier defines prognostic subtypes with greater accuracy than standard histologic classification.  The predictive capacity of the genomic model to guide the use and type of adjuvant chemotherapy remains unstudied.

Methods: A multi-institutional cohort of 185 resected ampullary adenocarcinoma patients with available targeted genomic sequencing was entered into the Hidden Genome multilevel meta-feature regression model to quantify the relative proportions of parental cancer sites (colorectal vs. pancreatobiliary). Overall survival (OS) was compared using Kaplan-Meier estimates, stratified by genomic subtype and use of adjuvant chemotherapy.

Results: Genomic subtype was significantly associated with OS (colorectal: median OS 76.9 [46.7-119.0] months vs. pancreatobiliary: median OS 36.5 [23.7-95.0] months; p=0.014). Adjuvant chemotherapy was frequently utilized (64.6%) and did not vary by genomic subtype (colorectal: 48/87 [57.8%]; pancreatobiliary: 52/75 [73.2%]; indeterminate: 13/23 [61.9%]; p=0.134). In the overall cohort, adjuvant chemotherapy was not associated with improved OS (median 54.0 [95% CI 39.9-77.9] months vs. 53.8 [95% CI 31.4-119.0] months, p=0.95). When stratified by genomic subtype, adjuvant chemotherapy was not associated with a survival benefit in the colorectal group (adjuvant 74.4 [46.7-97.8] months vs. no adjuvant 98.7 [32.4-NR] months); by contrast, survival was greater in the treated pancreatobiliary patients, but this difference did not reach significance (adjuvant 42.3 [23.7-95.0] vs. no adjuvant 24.0 [0-NR] months; p=0.147).

Conclusions:

Genomic classification of ampullary adenocarcinoma identified subtypes with distinct prognoses, although its role in selecting patients for adjuvant therapy requires clarification.

Learning Objectives:

  • Describe the genomic subtypes of ampullary adenocarcinoma
  • Describe the prognostic significance of the genomic subtypes of ampullary adenocarcinoma
  • Describe the role of adjuvant chemotherapy for resected ampullary adenocarcinoma