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10.11.2017 | Original Article | Ausgabe 4/2018

Journal of Gastrointestinal Surgery 4/2018

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

Zeitschrift:
Journal of Gastrointestinal Surgery > Ausgabe 4/2018
Autoren:
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
Wichtige Hinweise

Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1007/​s11605-017-3624-6 ) contains supplementary material, which is available to authorized users.

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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Zusatzmaterial
Supplementary Fig. 1 CONSORT diagram. ACRT = adjuvant chemoradiotherapy; ACT = adjuvant chemotherapy. (PDF 135 kb)
11605_2017_3624_MOESM1_ESM.pdf
Supplementary Fig. 2 Changes in the utilization of adjuvant therapy from 2004 to 2013. ACRT = adjuvant chemoradiotherapy; ACT = adjuvant chemotherapy. (PDF 111 kb)
11605_2017_3624_MOESM2_ESM.pdf
Literatur
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