Adjuvant therapy is associated with improved overall survival in patients with pancreatobiliary or mixed subtype ampullary cancer after pancreatoduodenectomy - A multicenter cohort study |
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| Institution: | 1. Department of Surgery, University Medical Center Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23562, Luebeck, Germany;2. Department of Surgery, Unit of Pancreatic Surgery, Humanitas Research Hospital, Via Alessandro Manzoni 56, 20089, Rozzano Milan, Italy;3. Department of Surgery, University Medical Center Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany;4. Department of Surgery, University Hospital Rostock, Schilling Allee 35, 18057 Rostock and Hospital Neumarkt in der Oberpfalz, Nürnberger Straße 12, 92318, Neumarkt in der Oberpfalz, Germany;5. Department for Visceral, Thoracic and Vascular Surgery, University Hospital, Technical University Dresden, Fetscherstraße 74, 01307, Dresden, Germany;6. School of Medicine and Surgery, Milano Bicocca University, Department of Surgery, San Gerardo Hospital, Piazza Dell’Ateneo Nuovo, 1, 20126, Milan, Italy;1. Division of Surgical Oncology, Department of Surgery, Northwestern Medicine Regional Medical Group, Northwestern University Feinberg School of Medicine, Chicago, IL, USA;2. Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA;3. Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA;4. Department of Medical Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA;5. Vernon Cancer Center, Newton-Wellesley Hospital, 2014 Washington Street, Newton, MA, 02462, USA;1. Department of Pancreatic Surgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, 200040, China;2. Department of Surgery, Zhongshan Hospital, Shanghai Medical College, Fudan University, Shanghai, 200032, China;1. Digestive Surgery, Nippon Medical School Musashikosugi Hospital, 211-8533, 1-396, Kosugicho, Nakaharaku, Kawasaki, Kanagawa, Japan;2. Center for Advanced Medical Innovation, Kyushu University, Fukuoka, Japan;3. Department of Surgery, Nippon Medical School, Tokyo, Japan;1. Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, Shanghai, 200032, China;2. Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China;3. Shanghai Pancreatic Cancer Institute, Shanghai, 200032, China;4. Pancreatic Cancer Institute, Fudan University, Shanghai, 200032, China |
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| Abstract: | Background/ObjectiveThe benefit of adjuvant therapy in ampullary cancer (AMPAC) patients following pancreatoduodenectomy (PD) is debated. The aim of this study was to determine the role of adjuvant therapy after pancreatoduodenectomy (PD) in histological subtypes of AMPAC.MethodsPatients undergoing PD for AMPAC at 5 high-volume European surgical centers from 1996 to 2017 were identified. Patient baseline characteristics, surgical and histopathological parameters, and long-term overall survival (OS) after resection were evaluated.Results214 patients undergoing PD for AMPAC were included. ASA score (ASA1-2 149 vs. ASA 3–4 82 months median OS, p = 0.002), preoperative serum CEA (CEA <0.5 ng/ml 128 vs. CEA >0.5 ng/ml 62 months, p = 0.013), preoperative serum CA19-9 (CA19-9 < 40 IU/ml 147 vs. CA19-9 > 40IU/ml 111 months, p = 0.042), T stage (T1-2 163 vs. T3-4 98 months, p < 0.001), N stage (N0 159 vs. N+ 110 months, p < 0.001), grading (G1-2 145 vs. G3-4 113 months, p = 0.026), R status (R0 136 vs. R+ 38 months, p = 0.031), and histological subtype (intestinal subtype 156 vs. PB/M subtype 118 months, p = 0.003) qualified as prognostic parameters. In multivariable analysis, ASA score (HR 1.784, 95%CI 0.997–3.193, p = 0.050) and N stage (HR 1.831, 95%CI 0.904–3.707, p = 0.033) remained independent prognostic factors. In PB/M subtype AMPAC, patients undergoing adjuvant therapy showed an improved median overall survival (adjuvant therapy 85 months vs. no adjuvant therapy 65 months, p = 0.005), and adjuvant therapy remained an independent prognostic parameter in multivariate analysis (HR 0.351, 95%CI 0.151–0.851, p = 0.015). There was no significant benefit of adjuvant therapy in intestinal subtype AMPAC patients.ConclusionAdjuvant treatment seems indicated in pancreatobiliary or mixed type AMPAC. |
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| Keywords: | Ampullary cancer Pancreatoduodenectomy Pancreatobiliary subtype Adjuvant therapy |
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