Impact of Adjuvant Therapy on the Overall Survival in Ampullary Cancer: A Systematic Review and Meta-Analysis

Abstract

Introduction: Ampullary cancers are rare tumors accounting for approximately 6-7% of all periampullary cancers. True ampullary cancers generally present at earlier stages owing to the rapid development of obstructive jaundice. Due to earlier presentation and tumor biology, ampullary cancers continually demonstrate the longest median overall survival amongst periampullary tumors. Several retrospective studies and propensity-matched cohort studies have shown significant benefit of adjuvant therapy for node positive disease or advanced stage disease. The aim of our study was to investigate any benefit of adjuvant therapy in early stage ampullary cancer. Method: Both Medline and EMBASE databases were searched to find eligible studies. Eligiable studies focused on resected ampullary cancer and provided information on overall survival and the impact of adjuvant therapy. Meta-analysis was performed and hazard ratios for the impact of adjuvant therapy on overall survival were pooled. Results: Overall, 9 retrospective reviews including 2,461 patients were included. The average 5-year overall survival was 51.4% with a median overall survival of 56 months. The pooled hazard ratio for adjuvant therapy on overall survival was 0.68 (95% CI 0.55 - 0.83), therefore, there was a demonstrated benefit of adjuvant therapy in improving overall survival. Conclusions: The role of adjuvant therapy in ampullary cancer is complex. The results of this meta-analysis show a significant benefit of adjuvant therapy on overall survival in patients with resectable ampullary cancer. Further study is needed in the way of randomized trials in order to validate the results seen of this meta-analysis of retrospective reviews.