{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,15]],"date-time":"2026-01-15T04:46:33Z","timestamp":1768452393389,"version":"3.49.0"},"reference-count":21,"publisher":"S. Karger AG","issue":"6","license":[{"start":{"date-parts":[[2020,1,1]],"date-time":"2020-01-01T00:00:00Z","timestamp":1577836800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.karger.com\/Services\/SiteLicenses"},{"start":{"date-parts":[[2020,1,1]],"date-time":"2020-01-01T00:00:00Z","timestamp":1577836800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.karger.com\/Services\/SiteLicenses"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Dig Surg"],"published-print":{"date-parts":[[2020]]},"abstract":"<b><i>Background:<\/i><\/b> The aim of this study is to compare the prognostic impact of 2 precursor lesions of ampullary adenocarcinoma, intra-ampullary papillary-tubular neoplasm (IAPN) and flat dysplasia (FD). <b><i>Methods:<\/i><\/b> From December 1994 to December 2012, a total of 359 patients underwent curative surgery for ampullary adenocarcinoma. <b><i>Results:<\/i><\/b> The precursor lesions were IAPNs in 134 (37.3%) patients and FD in the other 225 (62.7%) patients. The FD group had more aggressive tumor biology with advanced T stage (<i>p<\/i> = 0.002), nodal involvement (<i>p<\/i> &#x3c; 0.001), poor differentiation (<i>p<\/i> &#x3c; 0.001), perineural and lymphovascular invasion (<i>p<\/i> &#x3c; 0.001), and pancreatobiliary or mixed subtype (<i>p<\/i> &#x3c; 0.001). Five-year overall survival rates were 71.1% in the IAPN group and 51.4% in the FD group (<i>p<\/i> = 0.002), respectively. Five-year disease-free survival rates were 69.7% in the IAPN group and 49.6% in the FD group (<i>p<\/i> &#x3c; 0.001), respectively. The recurrence rate was also higher in the FD group (49.8 vs. 30.6%; <i>p<\/i> &#x3c; 0.001). On multivariate analysis, higher levels of tumor markers including CEA and CA19-9, lymph node metastasis, poorly differentiated histology, and perineural invasion were negative predictive factors for survival. Higher levels of CEA and CA19-9, lymphovascular invasion, and FD were independent prognostic factors for recurrence. <b><i>Conclusion:<\/i><\/b> FD was significantly associated with worse prognosis and a greater tendency toward advanced disease. Further studies are needed to clarify the impacts of these precursor lesions. <\/jats:p>","DOI":"10.1159\/000510961","type":"journal-article","created":{"date-parts":[[2020,10,20]],"date-time":"2020-10-20T21:00:35Z","timestamp":1603227635000},"page":"505-514","source":"Crossref","is-referenced-by-count":4,"title":["Prognostic Impact of Intra-Ampullary Papillary-Tubular Neoplasm versus Flat Dysplasia as Precursor Lesions of Ampullary Adenocarcinoma"],"prefix":"10.1159","volume":"37","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1235-7459","authenticated-orcid":false,"given":"Sunjong","family":"Han","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kee-Taek","family":"Jang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dong Wook","family":"Choi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Seong Ho","family":"Choi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jin Seok","family":"Heo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"In Woong","family":"Han","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"DaeJoon","family":"Park","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Youngju","family":"Ryu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"127","published-online":{"date-parts":[[2020,10,20]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","DOI":"10.1097\/00000658-199807000-00013"},{"key":"ref2","doi-asserted-by":"publisher","DOI":"10.1097\/00000658-199806000-00005"},{"key":"ref3","doi-asserted-by":"publisher","DOI":"10.1007\/s11605-009-1080-7"},{"key":"ref4","doi-asserted-by":"publisher","DOI":"10.1111\/j.1349-7006.1994.tb02077.x"},{"key":"ref5","doi-asserted-by":"publisher","DOI":"10.1007\/s00534-004-0894-7"},{"key":"ref6","doi-asserted-by":"publisher","DOI":"10.1097\/00000478-200407000-00005"},{"key":"ref7","doi-asserted-by":"publisher","DOI":"10.1016\/s0046-8177(85)80018-6"},{"key":"ref8","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2559.1988.tb01926.x"},{"key":"ref9","doi-asserted-by":"publisher","DOI":"10.1097\/PAS.0b013e3181f8ff05"},{"key":"ref10","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamcollsurg.2005.08.002"},{"key":"ref11","doi-asserted-by":"publisher","DOI":"10.1016\/s0039-6109(05)70142-0"},{"key":"ref12","doi-asserted-by":"publisher","DOI":"10.1001\/archsurg.134.5.526"},{"key":"ref13","doi-asserted-by":"publisher","DOI":"10.1097\/00000658-199705000-00015"},{"key":"ref14","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamcollsurg.2008.01.028"},{"key":"ref15","doi-asserted-by":"publisher","DOI":"10.1007\/s00268-006-0213-3"},{"key":"ref16","doi-asserted-by":"publisher","DOI":"10.1007\/s00534-007-1313-7"},{"key":"ref17","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2012.46.8868"},{"key":"ref18","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejso.2004.08.013"},{"key":"ref19","doi-asserted-by":"publisher","DOI":"10.1097\/00000658-199912000-00006"},{"key":"ref20","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2012.7352"},{"key":"ref21","doi-asserted-by":"publisher","DOI":"10.3748\/wjg.v20.i29.10144"}],"container-title":["Digestive Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.karger.com\/Article\/Pdf\/510961","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.karger.com\/Article\/Pdf\/510961","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,4,23]],"date-time":"2025-04-23T16:01:54Z","timestamp":1745424114000},"score":1,"resource":{"primary":{"URL":"https:\/\/karger.com\/article\/doi\/10.1159\/000510961"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020]]},"references-count":21,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2020,11,17]]},"published-print":{"date-parts":[[2020,11,17]]}},"URL":"https:\/\/doi.org\/10.1159\/000510961","archive":["Portico"],"relation":{},"ISSN":["0253-4886","1421-9883"],"issn-type":[{"value":"0253-4886","type":"print"},{"value":"1421-9883","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020]]}}}