Survival Benefit of Adjuvant Chemotherapy After Pancreatoduodenectomy for Ampullary Adenocarcinoma: a Propensity-Matched
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ORIGINAL ARTICLE
Survival Benefit of Adjuvant Chemotherapy After Pancreatoduodenectomy for Ampullary Adenocarcinoma: a Propensity-Matched National Cancer Database (NCDB) Analysis Sivesh K. Kamarajah 1,2,3
&
Filip Bednar 4 & Clifford S. Cho 4 & Hari Nathan 4
Received: 20 July 2020 / Accepted: 10 November 2020 # 2020 The Author(s)
Abstract Background 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. Methods Using 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. Results Of 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. Conclusion In 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. Keywords Ampullary cancer . Adjuvant therapy . Resection
Introduction 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 * Hari Nathan [email protected] 1
Department of Surgery, University Hospital Birmingham NHS Trust, Birmingham, UK
2
Department of Hepatobiliary, Pancreatic and Transplant Surgery, Freeman Hospital, Newcastle Upon Tyne, Tyne and Wear, UK
3
Department of Surgery, Freeman Hospital, Newcastle Upon Tyne, Tyne and Wear, UK
4
Department of Surgery, 2210A Taubman Health Care Center, University of Michigan, 1500 E Medical Center Dr, SPC 5343, Ann Arbor, MI 48109-5343, USA
70%.1–5 Despite this, up to 50% of patients have recurrence,6,7 with some series8,9 demonstrating similar rates of locoregional and distant recurrence while others10,11 suggesting predominance of distant recurrence. Adjuvant chemotherapy (AC) may help reduce both
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