Adjuvant chemoradiotherapy impact on the overall survival of completely resected ampullary and periampullary carcinoma: An updated meta-analysis.

Abstract

4645 Background: Ampullary and Periampullary carcinomas (APAC) are uncommon gastrointestinal cancers that are often amenable to surgical resection. The benefit of postoperative adjuvant chemoradiotherapy (ACRT) in patients with completely resected localized AC has been controversial. A meta-analysis which was conducted in 2017 found no associated survival benefit for adjuvant therapies in APAC. However, this meta-analysis was methodologically flawed and combined studies that used adjuvant chemotherapy alone with those that used ACRT. The purpose of this meta-analysis is to evaluate the impact of ACRT on the overall survival (OS) of patients with completely resected APAC incorporating more recent studies. Methods: A review of the medical literature was conducted using online databases. Inclusion criteria consisted of resected Ampullary and Periampullary carcinoma, English language, publications from 1999 to the present, comparative studies reporting OS with hazard ratios (HR) or Kaplan-Meier curves of patients that underwent ACRT versus those that did not, and studies that reported the aggregate OS data of adjuvant therapies where the preponderance of the cohort received ACRT. Adjuvant chemotherapy studies and those that reported aggregate OS for a cohort with preponderance of adjuvant chemotherapy were excluded. A meta-analysis was conducted using an inverse variance method with a random-effects model. Results: Sixteen retrospective series with a total of 1122 patients were included and analyzed. The majority of APAC patients that received ACRT tended to have high risk features. Four of these studies analyzed their OS data for the high risk APAC patients in addition to the cohort as a whole. Intra-arterial chemotherapy and concomitant radiotherapy was used in one study. ACRT was found to be significantly associated with better OS in patients with completely resected APAC (HR 0.76, 95%CI: 0.65-0.88, p < 0.001). Conclusions: This is the first meta-analysis to show that adjuvant chemoradiotherapy is associated with a survival benefit in patients with completely resected high risk Ampullary and Periampullary carcinoma. In the absence of randomized clinical trials, this meta-analysis represents the most compelling data supporting the use of ACRT in this patient population.