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Association of Adjuvant Therapy with Improved Survival in Ampullary Cancer: A National Cohort Study

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

There are limited data on the efficacy of adjuvant therapy in ampullary cancer. The aim of this study was to determine whether adjuvant therapy was associated with improved survival for patients with ampullary cancer.

Methods

From the National Cancer Database, we identified ampullary cancer patients who underwent resection between 2004 and 2013. We performed 1:1 propensity score matching, comparing patients who had postoperative observation to patients who received adjuvant chemotherapy (ACT) or adjuvant chemoradiotherapy (ACRT).

Results

We identified 4190 patients who fit our inclusion criteria; 63% had postoperative observation, 21% received ACT, and 16% underwent ACRT. In the matched cohorts, the use of ACT was associated with improved overall survival (HR = 0.82, 95% CI = 0.71 to 0.95). The median overall survival was 47.2 months for the ACT group and 35.5 months for the observation group. In a separate matched analysis, ACRT was also associated with improved survival (HR = 0.84, 95% CI = 0.72 to 0.98) as compared to observation. The median overall survival was 38.1 months for the ACRT group and 31.0 months for the observation group. The benefit was more pronounced in high-risk patients, such as ones with higher T and N categories.

Conclusions

In this retrospective study, the use of adjuvant therapy in ampullary cancer was associated with significantly improved overall survival. The benefit of adjuvant therapy for this disease should be confirmed in a more rigorous fashion via randomized controlled trials.

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Acknowledgments

The authors would like to thank Dave Primm for his help in editing this manuscript and Helen Mayo from the UT Southwestern Health Sciences Digital Library and Learning Center for the assistance with literature searches.

Funding

The National Center for Advancing Translational Sciences of the National Institutes of Health under award number UL1TR001105.

Author information

Authors and Affiliations

  1. Department of Surgery, Division of Surgical Oncology, University of Texas Southwestern Medical Center, Dallas, USA

    Ibrahim Nassour, Rebecca M. Minter, Adam C. Yopp, Michael A. Choti, John C. Mansour, Matthew R. Porembka & Sam C. Wang

  2. Departments of Clinical Sciences (Biostatistics) and Psychiatry, University of Texas Southwestern Medical Center, Dallas, USA

    Linda S. Hynan

  3. Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, USA

    Alana Christie, Rebecca M. Minter, Adam C. Yopp, Michael A. Choti, John C. Mansour, Matthew R. Porembka & Sam C. Wang

Authors
  1. Ibrahim Nassour
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  2. Linda S. Hynan
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  3. Alana Christie
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  4. Rebecca M. Minter
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  5. Adam C. Yopp
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  6. Michael A. Choti
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  7. John C. Mansour
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  8. Matthew R. Porembka
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  9. Sam C. Wang
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Contributions

Ibrahim Nassour, Linda Hynan, Alana Christie, and Sam Wang: study design, data analysis and interpretation, writing initial draft, revising and approving the final draft

Rebecca Minter, Adam Yopp, Michael Choti, John Mansour, and Matthew Porembka: data interpretation, revising and approving the final draft

Corresponding author

Correspondence to Sam C. Wang.

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Conflict of Interest

The authors declare that they have no conflict of interest.

Electronic Supplementary Materials

Supplementary Fig. 1

CONSORT diagram. ACRT = adjuvant chemoradiotherapy; ACT = adjuvant chemotherapy. (PDF 135 kb)

Supplementary Fig. 2

Changes in the utilization of adjuvant therapy from 2004 to 2013. ACRT = adjuvant chemoradiotherapy; ACT = adjuvant chemotherapy. (PDF 111 kb)

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Nassour, I., Hynan, L.S., Christie, A. et al. Association of Adjuvant Therapy with Improved Survival in Ampullary Cancer: A National Cohort Study. J Gastrointest Surg 22, 695–702 (2018). https://doi.org/10.1007/s11605-017-3624-6

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  • DOI: https://doi.org/10.1007/s11605-017-3624-6

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