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Gemcitabine-based adjuvant chemotherapy in subtypes of ampullary adenocarcinoma: international propensity score-matched cohort study

Gemcitabine-based adjuvant chemotherapy in subtypes of ampullary adenocarcinoma: international propensity score-matched cohort study
Gemcitabine-based adjuvant chemotherapy in subtypes of ampullary adenocarcinoma: international propensity score-matched cohort study

BACKGROUND: Whether patients who undergo resection of ampullary adenocarcinoma have a survival benefit from adjuvant chemotherapy is currently unknown. The aim of this study was to compare survival between patients with and without adjuvant chemotherapy after resection of ampullary adenocarcinoma in a propensity score-matched analysis.

METHODS: An international multicentre cohort study was conducted, including patients who underwent pancreatoduodenectomy for ampullary adenocarcinoma between 2006 and 2017, in 13 centres in six countries. Propensity scores were used to match patients who received adjuvant chemotherapy with those who did not, in the entire cohort and in two subgroups (pancreatobiliary/mixed and intestinal subtypes). Survival was assessed using the Kaplan-Meier method and Cox regression analyses.

RESULTS: Overall, 1163 patients underwent pancreatoduodenectomy for ampullary adenocarcinoma. After excluding 187 patients, median survival in the remaining 976 patients was 67 (95 per cent c.i. 56 to 78) months. A total of 520 patients (53·3 per cent) received adjuvant chemotherapy. In a propensity score-matched cohort (194 patients in each group), survival was better among patients who received adjuvant chemotherapy than in those who did not (median survival not reached versus 60 months respectively; P = 0·051). A survival benefit was seen in patients with the pancreatobiliary/mixed subtype; median survival was not reached in patients receiving adjuvant chemotherapy and 32 months in the group without chemotherapy (P = 0·020). Patients with the intestinal subtype did not show any survival benefit from adjuvant chemotherapy.

CONCLUSION: Patients with resected ampullary adenocarcinoma may benefit from gemcitabine-based adjuvant chemotherapy, but this effect may be reserved for those with the pancreatobiliary and/or mixed subtype.

0007-1323
1171-1182
Moekotte, A.L.
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Malleo, G.
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van Roessel, S.
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Bonds, M.
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Halimi, A.
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Zarantonello, L.
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Napoli, N.
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Dreyer, S.B.
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Wellner, U.F.
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Bolm, L.
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Mavroeidis, V.K.
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Robinson, S.
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Khalil, K.
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Ferraro, D.
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Mortimer, M.C.
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Harris, S.
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Al-Sarireh, B.
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Fusai, G.K.
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Roberts, K.J.
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Fontana, M.
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White, S.A.
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Soonawalla, Z.
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Jamieson, N.B.
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Boggi, U.
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Alseidi, A.
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Shablak, A.
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Wilmink, J.W.
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Primrose, J.N.
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Salvia, R.
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Bassi, C.
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Besselink, M.G.
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Abu Hilal, M.
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Moekotte, A.L.
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Malleo, G.
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van Roessel, S.
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Bonds, M.
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Halimi, A.
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Zarantonello, L.
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Napoli, N.
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Dreyer, S.B.
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Bolm, L.
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Mavroeidis, V.K.
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Khalil, K.
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Ferraro, D.
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Mortimer, M.C.
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Harris, S.
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Al-Sarireh, B.
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Fusai, G.K.
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White, S.A.
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Soonawalla, Z.
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Jamieson, N.B.
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Boggi, U.
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Alseidi, A.
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Shablak, A.
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Wilmink, J.W.
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Primrose, J.N.
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Salvia, R.
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Bassi, C.
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Besselink, M.G.
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Abu Hilal, M.
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Moekotte, A.L., Malleo, G., van Roessel, S., Bonds, M., Halimi, A., Zarantonello, L., Napoli, N., Dreyer, S.B., Wellner, U.F., Bolm, L., Mavroeidis, V.K., Robinson, S., Khalil, K., Ferraro, D., Mortimer, M.C., Harris, S., Al-Sarireh, B., Fusai, G.K., Roberts, K.J., Fontana, M., White, S.A., Soonawalla, Z., Jamieson, N.B., Boggi, U., Alseidi, A., Shablak, A., Wilmink, J.W., Primrose, J.N., Salvia, R., Bassi, C., Besselink, M.G. and Abu Hilal, M. (2020) Gemcitabine-based adjuvant chemotherapy in subtypes of ampullary adenocarcinoma: international propensity score-matched cohort study. British Journal of Surgery, 107 (9), 1171-1182. (doi:10.1002/bjs.11555).

Record type: Article

Abstract

BACKGROUND: Whether patients who undergo resection of ampullary adenocarcinoma have a survival benefit from adjuvant chemotherapy is currently unknown. The aim of this study was to compare survival between patients with and without adjuvant chemotherapy after resection of ampullary adenocarcinoma in a propensity score-matched analysis.

METHODS: An international multicentre cohort study was conducted, including patients who underwent pancreatoduodenectomy for ampullary adenocarcinoma between 2006 and 2017, in 13 centres in six countries. Propensity scores were used to match patients who received adjuvant chemotherapy with those who did not, in the entire cohort and in two subgroups (pancreatobiliary/mixed and intestinal subtypes). Survival was assessed using the Kaplan-Meier method and Cox regression analyses.

RESULTS: Overall, 1163 patients underwent pancreatoduodenectomy for ampullary adenocarcinoma. After excluding 187 patients, median survival in the remaining 976 patients was 67 (95 per cent c.i. 56 to 78) months. A total of 520 patients (53·3 per cent) received adjuvant chemotherapy. In a propensity score-matched cohort (194 patients in each group), survival was better among patients who received adjuvant chemotherapy than in those who did not (median survival not reached versus 60 months respectively; P = 0·051). A survival benefit was seen in patients with the pancreatobiliary/mixed subtype; median survival was not reached in patients receiving adjuvant chemotherapy and 32 months in the group without chemotherapy (P = 0·020). Patients with the intestinal subtype did not show any survival benefit from adjuvant chemotherapy.

CONCLUSION: Patients with resected ampullary adenocarcinoma may benefit from gemcitabine-based adjuvant chemotherapy, but this effect may be reserved for those with the pancreatobiliary and/or mixed subtype.

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Moekotte et al BJS 2020 - Accepted Manuscript
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Accepted/In Press date: 23 January 2020
e-pub ahead of print date: 7 April 2020
Published date: 7 April 2020

Identifiers

Local EPrints ID: 439601
URI: http://eprints.soton.ac.uk/id/eprint/439601
ISSN: 0007-1323
PURE UUID: 86f35e9d-6b01-4d74-afb3-9e18255a7008
ORCID for J.N. Primrose: ORCID iD orcid.org/0000-0002-2069-7605

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Date deposited: 28 Apr 2020 16:30
Last modified: 12 Jan 2022 05:01

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Contributors

Author: A.L. Moekotte
Author: G. Malleo
Author: S. van Roessel
Author: M. Bonds
Author: A. Halimi
Author: L. Zarantonello
Author: N. Napoli
Author: S.B. Dreyer
Author: U.F. Wellner
Author: L. Bolm
Author: V.K. Mavroeidis
Author: S. Robinson
Author: K. Khalil
Author: D. Ferraro
Author: M.C. Mortimer
Author: S. Harris
Author: B. Al-Sarireh
Author: G.K. Fusai
Author: K.J. Roberts
Author: M. Fontana
Author: S.A. White
Author: Z. Soonawalla
Author: N.B. Jamieson
Author: U. Boggi
Author: A. Alseidi
Author: A. Shablak
Author: J.W. Wilmink
Author: J.N. Primrose ORCID iD
Author: R. Salvia
Author: C. Bassi
Author: M.G. Besselink
Author: M. Abu Hilal

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