Annals of Hepato-Biliary-Pancreatic Surgery (한국간담췌외과학회지)

The Korean Association of Hepato-Biliary-Pancreatic Surgery (한국간담췌외과학회)
권호 표지
DOI QR코드

DOI QR Code

Role of adjuvant therapy in resected periampullary adenocarcinoma: A propensity matched case-control study

  • Anurita Srivastava (Department of Radiotherapy, Maulana Azad Medical College (MAMC)) ;
  • Phani Kumar Nekarakanti (Department of GI Surgery, Govind Ballabh Pant Institute of Postgraduate Medical Education & Research (GIPMER)) ;
  • Sudheer Kanchodu (Department of GI Surgery, Govind Ballabh Pant Institute of Postgraduate Medical Education & Research (GIPMER)) ;
  • Siddharth Srivastava (Department of Gastro Medicine, Govind Ballabh Pant Institute of Postgraduate Medical Education & Research (GIPMER)) ;
  • Pramod Kumar Mishra (Department of GI Surgery, Govind Ballabh Pant Institute of Postgraduate Medical Education & Research (GIPMER)) ;
  • Sundeep Singh Saluja (Department of GI Surgery, Govind Ballabh Pant Institute of Postgraduate Medical Education & Research (GIPMER))
  • Received : 2024.02.02
  • Accepted : 2024.03.07
  • Published : 2024.08.31
Download PDF
⟨ Previous Next ⟩

Abstract

Backgrounds/Aims: The published data had contradictory information on the role of adjuvant therapy on resected periampullary carcinomas (PACA). The study was performed to evaluate the survival benefit of adjuvant treatment. Methods: This was a propensity score matched case-control study from a prospectively maintained database from 2004-2019. The study included patients with nonpancreatic PACA who underwent curative resection. The patients (cases) who received adjuvant chemotherapy were compared with patients (controls) who were observed alone after surgery. Results: Of 510 patients with PACA, 230 patients (cases = 107, controls = 123) formed the unmatched study cohort. After propensity score matching, 140 patients (cases = 70, controls = 70) formed the matched study cohort. The median overall survival (OS) was similar in cases than controls in the unmatched population but doubled non-significantly in cases after matching (unmatched population, 54 months vs. 54 months, p-value = 0.624; matched population, 71 months vs. 36 months, p-value = 0.087). However, the median recurrence-free survival (RFS) was non significantly higher in the control group (unmatched population, 59 months vs. 38 months, p-value = 0.195; matched population, 53 months vs. 40 months, p-value = 0.797). In cox regression analysis, age < 60 years, advanced T stage, and presence of perineural invasion were independent factors for worse RFS, while tumor recurrence was an independent factor for poor OS. Conclusions: Patients with nonpancreatic PACA may have an OS benefit from adjuvant chemotherapy, and this needs to be validated with large prospective randomized studies.

Keywords

References

  1. Nakase A, Matsumoto Y, Uchida K, Honjo I. Surgical treatment of cancer of the pancreas and the periampullary region: cumulative results in 57 institutions in Japan. Ann Surg 1977;185:52-57.
  2. Todoroki T, Koike N, Morishita Y, Kawamoto T, Ohkohchi N, Shoda J, et al. Patterns and predictors of failure after curative resections of carcinoma of the ampulla of Vater. Ann Surg Oncol 2003;10:1176-1183.
  3. Howe JR, Klimstra DS, Moccia RD, Conlon KC, Brennan MF. Factors predictive of survival in ampullary carcinoma. Ann Surg 1998;228:87-94.
  4. Choi SB, Kim WB, Song TJ, Suh SO, Kim YC, Choi SY. Surgical outcomes and prognostic factors for ampulla of Vater cancer. Scand J Surg 2011;100:92-98.
  5. Riall TS, Cameron JL, Lillemoe KD, Winter JM, Campbell KA, Hruban RH, et al. Resected periampullary adenocarcinoma: 5-year survivors and their 6- to 10-year follow-up. Surgery 2006;140:764-772.
  6. Neoptolemos JP, Moore MJ, Cox TF, Valle JW, Palmer DH, McDonald AC, et al. Effect of adjuvant chemotherapy with fluorouracil plus folinic acid or gemcitabine vs observation on survival in patients with resected periampullary adenocarcinoma: the ESPAC-3 periampullary cancer randomized trial. JAMA 2012;308:147-156.
  7. Duan Z, Zhang Y, Tang Y, Gao R, Bao J, Liang B. Adjuvant therapy for periampullary carcinoma and the significance of histopathological typing: a systematic review. Transl Oncol 2022;20:101414.
  8. de Jong EJM, Mommers I, Farina Sarasqueta A, van der Geest LG, Heij L, de Hingh IHJT, et al. Adjuvant and first-line palliative chemotherapy regimens in patients diagnosed with periampullary cancer: a short report from a nationwide registry. Acta Oncol 2022;61:591-596.
  9. Balachandran P, Sikora SS, Kapoor S, Krishnani N, Kumar A, Saxena R, et al. Long-term survival and recurrence patterns in ampullary cancer. Pancreas 2006;32:390-395.
  10. Acharya A, Markar SR, Sodergren MH, Malietzis G, Darzi A, Athanasiou T, et al. Meta-analysis of adjuvant therapy following curative surgery for periampullary adenocarcinoma. Br J Surg 2017;104:814-822.
  11. Bhandare MS, Mondal A, Chaudhari V, Bal M, Yadav S, Ramaswamy A, et al. Factors influencing local and distant recurrence following resection of periampullary cancer. Br J Surg 2021;108:427-434.
  12. von Elm E, Altman DG, Egger M, Pocock SJ, Gotzsche PC, Vandenbroucke JP; STROBE Initiative. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol 2008;61:344-349.
  13. Ostwal V, Harris C, Sirohi B, Goel M, Bal M, Kannan S, et al. Role of adjuvant chemotherapy in T2N0M0 periampullary cancers. Asia Pac J Clin Oncol 2017;13:e298-e303.
  14. Sunil BJ, Seshadri RA, Gouthaman S, Ranganathan R. Long-term outcomes and prognostic factors in periampullary carcinoma. J Gastrointest Cancer 2017;48:13-19.
  15. Park HM, Park SJ, Han SS, Hong SK, Hong EK, Kim SW. Very early recurrence following pancreaticoduodenectomy in patients with ampullary cancer. Medicine (Baltimore) 2019;98:e17711.
  16. Kim H, Kwon W, Kim JR, Byun Y, Jang JY, Kim SW. Recurrence patterns after pancreaticoduodenectomy for ampullary cancer. J Hepato-Biliary-Pancreat Sci 2019;26:179-186.
  17. Bhatia S, Miller RC, Haddock MG, Donohue JH, Krishnan S. Adjuvant therapy for ampullary carcinomas: the Mayo Clinic experience. Int J Radiat Oncol Biol Phys 2006;66:514-519.
  18. Ghosn M, Kourie HR, El Rassy E, Haddad FG, Hanna C, El Karak F, et al. Where does chemotherapy stands in the treatment of ampullary carcinoma? A review of literature. World J Gastrointest Oncol 2016;8:745-750.
  19. Klinkenbijl JH, Jeekel J, Sahmoud T, van Pel R, Couvreur ML, Veenhof CH, et al. Adjuvant Radiotherapy and 5-fluorouracil after curative resection of cancer of the pancreas and periampullary region: phase III trial of the EORTC gastrointestinal tract cancer cooperative group. Ann Surg 1999;230:776-782; discussion 782-784.
  20. Morak MJM, van der Gaast A, Incrocci L, van Dekken H, Hermans JJ, Jeekel J, et al. Adjuvant intra-arterial chemotherapy and radiotherapy versus surgery alone in resectable pancreatic and periampullary cancer: a prospective randomized controlled trial. Ann Surg 2008;248:1031-1041.
  21. Smeenk HG, van Eijck CHJ, Hop WC, Erdmann J, Tran KC, Debois M, et al. Long-term survival and metastatic pattern of pancreatic and periampullary cancer after adjuvant chemoradiation or observation: long-term results of EORTC trial 40891. Ann Surg 2007;246:734-740.
  22. Kamarajah SK, Bednar F, Cho CS, Nathan H. Survival benefit of adjuvant chemotherapy after pancreatoduodenectomy for ampullary adenocarcinoma: a propensity-Matched National Cancer Database (NCDB) analysis. J Gastrointest Surg 2021;25:1805-1814.
  23. Kim HS, Jang JY, Yoon YS, Park SJ, Kwon W, Kim SW, et al. Does adjuvant treatment improve prognosis after curative resection of ampulla of Vater carcinoma? A multicenter retrospective study. J Hepatobiliary Pancreat Sci 2020;27:721-730.
  24. Swaminathan R, Rama R, Shanta V. Lack of active follow-up of cancer patients in Chennai, India: implications for population-based survival estimates. Bull World Health Organ 2008;86:509-515.