{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,17]],"date-time":"2026-04-17T19:27:18Z","timestamp":1776454038107,"version":"3.51.2"},"reference-count":18,"publisher":"MDPI AG","issue":"16","license":[{"start":{"date-parts":[[2025,8,20]],"date-time":"2025-08-20T00:00:00Z","timestamp":1755648000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Adenocarcinoma arising from the ampulla of Vater is an extremely rare neoplasm, and there are limited data regarding frontline therapy for metastatic disease. We investigated the outcomes of first-line treatment with FOLFIRINOX by comparing it with other treatments in patients with advanced ampullary adenocarcinoma. Methods: We included 123 patients with advanced ampullary adenocarcinoma who were treated with frontline FOLFIRINOX (n = 32), fluorouracil (FU)-based chemotherapy (n = 20), and gemcitabine-based chemotherapy (n = 65) between August 2007 and January 2024 in this retrospective study. The median progression-free survival (mPFS) and overall survival (mOS) according to treatment and clinicopathological features were calculated using the Kaplan\u2013Meier method. Results: The median age of the patients was 62 years (range, 36\u201378), and 75,6% of the patients had an ECOG performance status of 0\u20131. The mOS were 13 months (95% CI, 10.6\u201314.4), 11 months (95% CI, 10.6\u201314.4), and 12 months (95% CI, 10.6\u201314.4), respectively [p = 0.865]. There were no significant differences in OS among the chemotherapeutic agents according to histological subtypes. However, FOLFIRINOX and FU-based treatments appeared more effective in the intestinal subtype, while gemcitabine-based therapies were less effective. In the pancreaticobiliary subtype, FU-based therapies yielded a shorter outcome compared to FOLFIRINOX and gemcitabine-based therapies. Grade 3 or 4 hematologic toxicities were higher in patients treated with FOLFIRINOX. Conclusions: In advanced ampullary adenocarcinoma, despite higher toxicity, frontline FOLFIRINOX showed a trend toward an OS benefit in the intestinal subtype while providing a similar outcome in the pancreaticobiliary subtype.<\/jats:p>","DOI":"10.3390\/jcm14165868","type":"journal-article","created":{"date-parts":[[2025,8,20]],"date-time":"2025-08-20T15:53:37Z","timestamp":1755705217000},"page":"5868","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Comparison of Frontline FOLFIRINOX with Fluorouracil-Based and Gemcitabine-Based Chemotherapies in Metastatic Ampullary Adenocarcinoma: A Multicenter Study by the Turkish Oncology Group (TOG)"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-0937-0468","authenticated-orcid":false,"given":"Ali","family":"Kalem","sequence":"first","affiliation":[{"name":"Department of Medical Oncology, School of Medicine, Gaziantep University, Gaziantep 27310, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5781-4820","authenticated-orcid":false,"given":"Tulay","family":"Kus","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, School of Medicine, Gaziantep University, Gaziantep 27310, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Savas","family":"Gokcek","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, School of Medicine, Dokuz Eylul University, Izmir 35220, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9124-6123","authenticated-orcid":false,"given":"Ilkay Tugba","family":"Unek","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, School of Medicine, Dokuz Eylul University, Izmir 35220, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3590-0426","authenticated-orcid":false,"given":"Taha Koray","family":"Sahin","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, School of Medicine, Hacettepe University, Ankara 06800, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Omer","family":"Dizdar","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, School of Medicine, Hacettepe University, Ankara 06800, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Muhammed Fatih","family":"Sag\u0131roglu","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Gaziantep City Hospital, Gaziantep 27100, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8659-7327","authenticated-orcid":false,"given":"Hatice","family":"Bolek","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, School of Medicine, Ankara University, Ankara 06620, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuksel","family":"Urun","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, School of Medicine, Ankara University, Ankara 06620, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5264-8405","authenticated-orcid":false,"given":"Sendag","family":"Yasl\u0131kaya","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, School of Medicine, \u00c7ukurova University, Adana 01330, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ertugrul","family":"Bayram","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, School of Medicine, \u00c7ukurova University, Adana 01330, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7312-3827","authenticated-orcid":false,"given":"Nadiye","family":"Sever","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, School of Medicine, Marmara University, \u0130stanbul 34854, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0481-1084","authenticated-orcid":false,"given":"Ibrahim Vedat","family":"Bayo\u011flu","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, School of Medicine, Marmara University, \u0130stanbul 34854, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Omer","family":"Acar","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, School of Medicine, Manisa Celal Bayar University, Manisa 45140, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4859-7574","authenticated-orcid":false,"given":"Atike P\u0131nar","family":"Erdogan","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, School of Medicine, Manisa Celal Bayar University, Manisa 45140, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5916-6265","authenticated-orcid":false,"given":"Seray","family":"Saray","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Ataturk Education and Research Hospital, Bal\u0131kesir 10100, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5357-7610","authenticated-orcid":false,"given":"Berkan","family":"Karabuga","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Dr. Abdurrahman Yurtaslan Oncology Education and Research Hospital, Ankara 06200, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ulku","family":"Arslan Yalc\u0131ntas","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Dr. Abdurrahman Yurtaslan Oncology Education and Research Hospital, Ankara 06200, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Safa Can","family":"Efil","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, School of Medicine, Ankara Y\u0131ld\u0131r\u0131m Beyaz\u0131t University, Ankara 06690, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7021-6139","authenticated-orcid":false,"given":"Mehmet Ali Nahit","family":"Sendur","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, School of Medicine, Ankara Y\u0131ld\u0131r\u0131m Beyaz\u0131t University, Ankara 06690, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9614-0651","authenticated-orcid":false,"given":"Talat","family":"Aykut","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, School of Medicine, Necmettin Erbakan University, Konya 42090, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4632-9501","authenticated-orcid":false,"given":"Murat","family":"Araz","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, School of Medicine, Necmettin Erbakan University, Konya 42090, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tugce Kubra","family":"Gunes","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, \u00dcmraniye Education and Research Hospital, \u0130stanbul 34764, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Melike","family":"Ozcelik","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, \u00dcmraniye Education and Research Hospital, \u0130stanbul 34764, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4841-7994","authenticated-orcid":false,"given":"Mustafa","family":"Seyyar","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Gaziantep City Hospital, Gaziantep 27100, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gokmen","family":"Aktas","sequence":"additional","affiliation":[{"name":"Gaziantep Medical Point Private Hospital, Gaziantep 27584, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Suayib","family":"Yalc\u0131n","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, School of Medicine, Hacettepe University, Ankara 06800, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,8,20]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2349","DOI":"10.1093\/annonc\/mdt191","article-title":"A retrospective study of ampullary adenocarcinomas: Overall survival and responsiveness to fluoropyrimidine-based chemotherapy","volume":"24","author":"Jiang","year":"2013","journal-title":"Ann. 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Available online: https:\/\/www.nccn.org\/professionals\/physician_gls\/pdf\/ampullary.pdf."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/16\/5868\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:31:30Z","timestamp":1760034690000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/16\/5868"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,20]]},"references-count":18,"journal-issue":{"issue":"16","published-online":{"date-parts":[[2025,8]]}},"alternative-id":["jcm14165868"],"URL":"https:\/\/doi.org\/10.3390\/jcm14165868","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,20]]}}}