Gemcitabine-based adjuvant chemotherapy in subtypes of ampullary adenocarcinoma: international propensity score-matched cohort study

Abstract

Background Whether patients who are resected for ampullary adenocarcinoma have a survival benefit from adjuvant chemotherapy is currently not known. The aim of this study was to compare propensity score-matched survival between patients with and without adjuvant chemotherapy after resection of ampullary adenocarcinoma. Methods An international multicentre cohort study was conducted, including patients who underwent pancreatoduodenectomy for ampullary adenocarcinoma (2006-2017) in 13 centres in six countries. Propensity scores were used to match patients who received adjuvant chemotherapy to those who did not; both in the entire cohort and in two subgroups (pancreaticobiliary/mixed and intestinal subtype). Survival was assessed using the Kaplan-Meier method and Cox regressions. Results Overall, 1163 patients underwent pancreatoduodenectomy for ampullary adenocarcinoma. After excluding 179 patients, median survival in the resulting 976 patients was 67 months (95 per cent confidence interval 56-78), of which a total of 520 (53 per cent) patients received adjuvant chemotherapy. In a propensity-matched cohort (194 vs 194 patients), median survival was better after adjuvant chemotherapy compared to those without adjuvant chemotherapy (median survival not reached vs 60 months, respectively; p=0.051). In the pancreaticobiliary/mixed subtype a survival benefit was seen; median survival was not reached in patients receiving adjuvant chemotherapy vs 32 months in the group without chemotherapy, p=0.020. The intestinal subtype did not show survival benefit from adjuvant chemotherapy. Conclusions Patients with resected ampullary adenocarcinoma may benefit from gemcitabinebased adjuvant chemotherapy, but this effect may be reserved for those with the pancreaticobiliary and/or mixed subtype.

Survival Benefit of Adjuvant Chemotherapy After Pancreatoduodenectomy for Ampullary Adenocarcinoma: a Propensity-Matched National Cancer Database (NCDB) Analysis

“…Current evidence for AC in resected ampullary adenocarcinoma is limited to retrospective case series. Recent institutional series by Ecker et al 26 (n = 357 patients; HR: 0.90; CI 95% : 0.51-1.56), Bolm et al 30 with 214 patients (median: 85.0 vs 65.0 months), and Moekotte et al 31 with 1,163 patients (median: not reached vs 32 months) demonstrated no survival benefit with AC. However, these studies are limited by small institutional cohorts and selection bias.…”

“…Retrospective single-center, multi-institutional series offer conflicting evidence regarding the benefit of AC. 2,10,[25][26][27][28][29][30][31] Therefore, the use of AC after pancreatoduodenectomy (PD) for ampullary adenocarcinoma remains controversial, especially in patients thought to be at a lower risk for recurrence, such as those with margin-negative resections and node-negative disease.…”

Preoperative misdiagnosis of pancreatic and periampullary cancer in patients undergoing pancreatoduodenectomy: A multicentre retrospective cohort study

“…Cumulative percentages may not exactly equal 100% due to rounding. than distinction based on anatomical site of tumour origin [19]. Further studies on the efficacy of neoadjuvant regimens for periampullary cancers are to be awaited, as is conclusive evidence on the effect of neoadjuvant therapy for (resectable) pancreatic cancer.…”

Adjuvant Chemotherapy in the Treatment of Intraductal Papillary Mucinous Neoplasms of the Pancreas: Systematic Review and Meta‐Analysis

“…A consequence of the wider use of gemcitabine-based chemotherapy may be an underestimation of efficacy of adjuvant chemotherapy in the treatment of IIPMNs. However, emerging evidence seemed to suggest that there is a limit to generalisability of results from existing trials to other types of pancreatic cancers owing to differences in tumour biology [ 40 , 41 ]. IIPMNs subtype is a well-established prognostic marker [ 32 , 38 , 42 ].…”