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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))
  • 투고 : 2024.02.02
  • 심사 : 2024.03.07
  • 발행 : 2024.08.31

초록

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.

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참고문헌

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