Neoadjuvant vs Adjuvant Chemotherapy in Resected Ampullary Carcinoma: A Propensity-Matched Cohort Analysis

Abstract

INTRODUCTION: During the COVID-19 pandemic, many hospitals employed neoadjuvant chemotherapy (NAC) to delay oncologic resections to mitigate resource strain. But the role of neoadjuvant chemotherapy in ampullary carcinoma is unclear. This study aimed to compare outcomes of NAC and adjuvant chemotherapy (AC) for surgically treated patients with ampullary carcinoma. METHODS: The National Cancer Database was queried for patients with stage I to III ampullary carcinoma diagnosed between 2004 and 2017 and treated with both chemotherapy and surgery. Factors associated with receiving NAC were identified. Patients in the NAC group were propensity matched in a 1:5 ratio with patients in the AC group by using the nearest neighbor method. Odds of negative resection margin and overall survival for the matched groups were compared using Fisher’s Exact test and Cox hazards regressions, respectively. RESULTS: Of 3,930 patients included in the study, 137 (3.5%) received NAC. Patients were more likely to receive NAC if they had stage I disease (odds ratio [OR] 3.12, 1.87 to 5.22 vs stage III), were treated in the Midwest (OR 2.25, 1.10 to 4.58 vs the West) or were age 65 or older (OR 1.98, 1.13 to 3.46). There were no differences between the matched NAC and AC groups for any stage in rate of negative surgical margins or overall survival (Table) Table. - Outcomes Associated with Neoadjuvant Chemotherapy for Resected Ampullary Carcinoma *Matched AC group as reference NAC odds ratio* (95% CI) for negative surgical margin p Value Hazard ratio* (95% CI) for death p Value Stage I 0.85 (0.08–42.8) 1.000 1.10 (0.49–2.46) 0.817 Stage II 0.85 (0.22–4.84) 0.735 1.15 (0.75–1.77) 0.510 Stage III 1.72 (0.37–16.1) 0.743 0.65 (0.37–1.12) 0.117 CONCLUSION: We found that NAC is rarely used in the treatment of ampullary carcinoma. However, it is associated with outcomes similar to AC for this disease. Delay of surgical resection through utilization of NAC may be reasonable for this population when necessary.