Abstract
BackgroundThe benefit of adjuvant chemotherapy (AC) after pancreatoduodenectomy (PD) for ampullary adenocarcinoma is uncertain. We aimed to evaluate the association of AC with survival in patients with resected ampullary adenocarcinoma. MethodsUsing the National Cancer Database (NCDB) data from 2004 to 2016, patients with non-metastatic ampullary adenocarcinoma who underwent PD were identified. Patients with neoadjuvant radiotherapy and chemotherapy and survival < 6 months were excluded. Propensity score matching was used to account for treatment selection bias. A multivariable Cox proportional hazards model was then used to analyze the association of AC with survival. ResultsOf 3186 (43%) AC and 4172 (57%) no AC (noAC) patients, 1720 AC and 1720 noAC patients remained in the cohort after matching. Clinicopathologic variables were well balanced after matching. After matching, AC was associated with improved survival (median 47.5 vs 39.6 months, p = 0.003), which remained after multivariable adjustment (HR: 0.83, CI95%: 0.76–0.91, p < 0.001). Multivariable interaction analyses showed that this benefit was seen irrespective of nodal status: N0 (HR: 0.81, CI95%: 0.68–0.97, p < 0.001), N1 (HR: 0.65, CI95%: 0.61–0.70, p < 0.001), N2 (HR: 0.73, CI95%: 0.59–0.90, p = 0.003), N3 (HR: 0.59, CI95%: 0.44–0.78, p < 0.001); and margin status: R0 (HR: 0.85, CI95%: 0.77–0.94, p < 0.001), R1 (HR: 0.69, CI95%: 0.48–1.00, p < 0.001). Stratified analyses by nodal and margin status demonstrated consistent results. ConclusionIn this large retrospective cohort study, AC after resected ampullary adenocarcinoma was associated with a survival benefit in patients, including patients with node-negative and margin-negative disease.
Highlights
IntroductionAmpullary adenocarcinoma typically has a better long-term prognosis after curative resection than other periampullary cancers, with 5-year survival rates ranging from 30 to Department of Surgery, University Hospital Birmingham NHS Trust, Birmingham, UK
Baseline demographics of the unmatched cohort revealed that patients receiving adjuvant chemotherapy (AC) were from high hospital volume and younger and had lower comorbidity burden (Table 1)
Patients receiving AC had significantly higher rates of lymph nodes examined compared to no AC (noAC)
Summary
Ampullary adenocarcinoma typically has a better long-term prognosis after curative resection than other periampullary cancers, with 5-year survival rates ranging from 30 to Department of Surgery, University Hospital Birmingham NHS Trust, Birmingham, UK. While multiple randomized controlled trials have conclusively established the survival benefit of AC for pancreatic cancer,[12,13,14,15,16,17] its role is not yet clear for ampullary adenocarcinoma. Randomized controlled trials (RCTs)[18,19,20,21] and meta-analyses[22,23] have demonstrated no survival benefit. The benefit of adjuvant chemotherapy (AC) after pancreatoduodenectomy (PD) for ampullary adenocarcinoma is uncertain. We aimed to evaluate the association of AC with survival in patients with resected ampullary adenocarcinoma
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