Journal of Gastrointestinal Surgery

, Volume 22, Issue 4, pp 695–702 | Cite as

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

  • Ibrahim Nassour
  • Linda S. Hynan
  • Alana Christie
  • Rebecca M. Minter
  • Adam C. Yopp
  • Michael A. Choti
  • John C. Mansour
  • Matthew R. Porembka
  • Sam C. Wang
Original Article

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.

Keywords

Adjuvant therapy Ampullary cancer Ampullary carcinoma Chemotherapy Chemoradiation 

Notes

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.

Author 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

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Supplementary material

11605_2017_3624_MOESM1_ESM.pdf (136 kb)
Supplementary Fig. 1 CONSORT diagram. ACRT = adjuvant chemoradiotherapy; ACT = adjuvant chemotherapy. (PDF 135 kb)
11605_2017_3624_MOESM2_ESM.pdf (112 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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Copyright information

© The Society for Surgery of the Alimentary Tract 2017

Authors and Affiliations

  • Ibrahim Nassour
    • 1
  • Linda S. Hynan
    • 2
  • Alana Christie
    • 3
  • Rebecca M. Minter
    • 1
    • 3
  • Adam C. Yopp
    • 1
    • 3
  • Michael A. Choti
    • 1
    • 3
  • John C. Mansour
    • 1
    • 3
  • Matthew R. Porembka
    • 1
    • 3
  • Sam C. Wang
    • 1
    • 3
  1. 1.Department of Surgery, Division of Surgical OncologyUniversity of Texas Southwestern Medical CenterDallasUSA
  2. 2.Departments of Clinical Sciences (Biostatistics) and PsychiatryUniversity of Texas Southwestern Medical CenterDallasUSA
  3. 3.Harold C. Simmons Comprehensive Cancer CenterUniversity of Texas Southwestern Medical CenterDallasUSA

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