Cancer Res Treat.  2021 Apr;53(2):424-435. 10.4143/crt.2020.953.

Adjuvant Chemotherapy for Resected Ampulla of Vater Carcinoma: Retrospective Analysis of 646 Patients

Affiliations
  • 1Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
  • 2Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
  • 3Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

Abstract

Purpose
This study evaluated the efficacy of adjuvant chemotherapy (AC) in patients with resected ampulla of Vater (AoV) carcinoma.
Materials and Methods
Data from 646 patients who underwent surgical resection at Asan Medical Center between 2000 and 2017 were retrospectively reviewed.
Results
The median age of the patients was 62 years, and 54.2% were male. Patients were classified into AC group (n=165, 25.5%) and no AC group (n=481, 74.5%). With a median follow-up duration of 88 months, in patients with stage I, II, III, median recurrence-free survival (RFS) was not reached, 44 months, and 15 months, respectively, and the median overall survival (OS) were not reached, 88 months and 35 months, respectively. Despite no statistical significance, RFS and OS were better in stage II patients with AC than in those without AC (median RFS, 151 months vs. 38 months; p=0.156 and median OS, 153 months vs. 74 months; p=0.299). In multivariate analysis for RFS and OS, TNM stage, R1 resection status, presence of lymphovascular invasion, and perineural invasion remained significant factors, whereas AC (hazard ratio [HR], 0.74; 95% confidence interval [CI], 0.54 to 1.00; p=0.052) was marginally related with RFS. After propensity score matching in only stage II/III patients, RFS and OS with AC were numerically longer than those without AC (HR, 0.80; 95% CI, 0.60 to 1.06; p=0.116 and HR, 0.77; 95% CI, 0.56 to 1.06; p=0.111).
Conclusion
AC with fluoropyrimidine did not improve survival of patients with resected AoV carcinoma. However, multivariate analysis with prognostic factors showed a marginally significant survival benefit with AC.

Keyword

Ampulla of Vater carcinoma; Adjuvant chemotherapy; Fluoropyrimidine; Survival

Figure

  • Fig. 1 Consort diagram. AoV, ampulla of Vater; CCRT, concurrent chemoradiation therapy; 5-FU, fluorouracil.

  • Fig. 2 Kaplan-Meier curves for recurrence-free survival (A) and overall survival (B) according to TNM stage.

  • Fig. 3 Kaplan-Meier curves for recurrence-free survival (A) and overall survival (B) according to the presence or absence of adjuvant chemotherapy (AC) in stage II patients, and recurrence-free survival (C) and overall survival (D) according to the presence or absence of AC in stage III patients.

  • Fig. 4 Kaplan-Meier curves for recurrence-free survival (A) and overall survival (B) in matched patients with stage II/III disease. AC, adjuvant chemotherapy.

  • Fig. 5 Kaplan-Meier curves for recurrence-free survival (A) and overall survival (B) according to time period.


Reference

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