Ann Hepatobiliary Pancreat Surg.  2024 Aug;28(3):371-380. 10.14701/ahbps.24-032.

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

• Srivastava A
• Nekarakanti PK
• Kanchodu S
• Srivastava S
• Mishra PK
• Saluja SS

• KMID: 2558652
• DOI: http://doi.org/10.14701/ahbps.24-032

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.

Keyword

Ampulla of Vater; Adjuvant chemotherapy; Surgery

Figure

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  Fig. 1 Flow chart of patient selection. ECOG, Eastern Cooperative Oncology Group.

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  Fig. 2 (A) Overall survival between two treatment groups before matching. (B) Overall survival between two treatment groups after matching. HR, hazard ratio; CI, confidence interval.

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  Fig. 3 (A) Recurrence-free survival between two treatment groups before matching. (B) Recurrence-free survival between two treatment groups after matching. HR, hazard ratio; CI, confidence interval.

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  Fig. 4 Forrest plot of various factors for overall survival in a matched population. HR, hazard ratio; CI, confidence interval; PNI, perineural invasion; LNR, lymph node ratio; WD, well differentiation; MD, moderately differentiation; PD, poorly differentiation.

Reference

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