Abstract
Importance: Ampullary adenocarcinoma is a rare malignant neoplasm that arises within the duodenal ampullary complex. The role of adjuvant therapy (AT) in the treatment of ampullary adenocarcinoma has not been clearly defined. Objective: To determine if long-term survival after curative-intent resection of ampullary adenocarcinoma may be improved by selection of patients for AT directed by histologic subtype. Design, Setting, and Participants: This multinational, retrospective cohort study was conducted at 12 institutions from April 1, 2000, to July 31, 2017, among 357 patients with resected, nonmetastatic ampullary adenocarcinoma receiving surgery alone or AT. Cox proportional hazards regression was used to identify covariates associated with overall survival. The surgery alone and AT cohorts were matched 1:1 by propensity scores based on the likelihood of receiving AT or by survival hazard from Cox modeling. Overall survival was compared with Kaplan-Meier estimates. Exposures: Adjuvant chemotherapy (fluorouracil- or gemcitabine-based) with or without radiotherapy. Main Outcomes and Measures: Overall survival. Results: A total of 357 patients (156 women and 201 men; median age, 65.8 years [interquartile range, 58-74 years]) underwent curative-intent resection of ampullary adenocarcinoma. Patients with intestinal subtype had a longer median overall survival compared with those with pancreatobiliary subtype (77 vs 54 months; P =.05). Histologic subtype was not associated with AT administration (intestinal, 52.9% [101 of 191]; and pancreatobiliary, 59.5% [78 of 131]; P =.24). Patients with pancreatobiliary histologic subtype most commonly received gemcitabine-based regimens (71.0% [22 of 31]) or combinations of gemcitabine and fluorouracil (12.9% [4 of 31]), whereas treatment of those with intestinal histologic subtype was more varied (fluorouracil, 50.0% [17 of 34]; gemcitabine, 44.1% [15 of 34]; P =.01). In the propensity score-matched cohort, AT was not associated with a survival benefit for either histologic subtype (intestinal: hazard ratio, 1.21; 95% CI, 0.67-2.16; P =.53; pancreatobiliary: hazard ratio, 1.35; 95% CI, 0.66-2.76; P =.41). Conclusions and Relevance: Adjuvant therapy was more frequently used in patients with poor prognostic factors but was not associated with demonstrable improvements in survival, regardless of tumor histologic subtype. The value of a multimodality regimen remains poorly defined..
| Original language | English (US) |
|---|---|
| Journal | JAMA Surgery |
| DOIs | |
| State | Published - Jan 1 2019 |
| Externally published | Yes |
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ASJC Scopus subject areas
- Surgery
Cite this
Role of Adjuvant Multimodality Therapy after Curative-Intent Resection of Ampullary Carcinoma. / Ecker, Brett L.; Vollmer, Charles M.; Behrman, Stephen W.; Allegrini, Valentina; Aversa, John; Ball, Chad G.; Barrows, Courtney E.; Berger, Adam C.; Cagigas, Martha N.; Christein, John D.; Dixon, Elijah; Fisher, William E.; Freedman-Weiss, Mollie; Guzman-Pruneda, Francisco; Hollis, Robert H.; House, Michael G.; Kent, Tara S.; Kowalsky, Stacy J.; Malleo, Giuseppe; Salem, Ronald R.; Salvia, Roberto; Schmidt, Carl R.; Seykora, Thomas F.; Zheng, Richard; Zureikat, Amer H.; Dickson, Paxton V.
In: JAMA Surgery, 01.01.2019.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Role of Adjuvant Multimodality Therapy after Curative-Intent Resection of Ampullary Carcinoma
AU - Ecker, Brett L.
AU - Vollmer, Charles M.
AU - Behrman, Stephen W.
AU - Allegrini, Valentina
AU - Aversa, John
AU - Ball, Chad G.
AU - Barrows, Courtney E.
AU - Berger, Adam C.
AU - Cagigas, Martha N.
AU - Christein, John D.
AU - Dixon, Elijah
AU - Fisher, William E.
AU - Freedman-Weiss, Mollie
AU - Guzman-Pruneda, Francisco
AU - Hollis, Robert H.
AU - House, Michael G.
AU - Kent, Tara S.
AU - Kowalsky, Stacy J.
AU - Malleo, Giuseppe
AU - Salem, Ronald R.
AU - Salvia, Roberto
AU - Schmidt, Carl R.
AU - Seykora, Thomas F.
AU - Zheng, Richard
AU - Zureikat, Amer H.
AU - Dickson, Paxton V.
PY - 2019/1/1
Y1 - 2019/1/1
N2 - Importance: Ampullary adenocarcinoma is a rare malignant neoplasm that arises within the duodenal ampullary complex. The role of adjuvant therapy (AT) in the treatment of ampullary adenocarcinoma has not been clearly defined. Objective: To determine if long-term survival after curative-intent resection of ampullary adenocarcinoma may be improved by selection of patients for AT directed by histologic subtype. Design, Setting, and Participants: This multinational, retrospective cohort study was conducted at 12 institutions from April 1, 2000, to July 31, 2017, among 357 patients with resected, nonmetastatic ampullary adenocarcinoma receiving surgery alone or AT. Cox proportional hazards regression was used to identify covariates associated with overall survival. The surgery alone and AT cohorts were matched 1:1 by propensity scores based on the likelihood of receiving AT or by survival hazard from Cox modeling. Overall survival was compared with Kaplan-Meier estimates. Exposures: Adjuvant chemotherapy (fluorouracil- or gemcitabine-based) with or without radiotherapy. Main Outcomes and Measures: Overall survival. Results: A total of 357 patients (156 women and 201 men; median age, 65.8 years [interquartile range, 58-74 years]) underwent curative-intent resection of ampullary adenocarcinoma. Patients with intestinal subtype had a longer median overall survival compared with those with pancreatobiliary subtype (77 vs 54 months; P =.05). Histologic subtype was not associated with AT administration (intestinal, 52.9% [101 of 191]; and pancreatobiliary, 59.5% [78 of 131]; P =.24). Patients with pancreatobiliary histologic subtype most commonly received gemcitabine-based regimens (71.0% [22 of 31]) or combinations of gemcitabine and fluorouracil (12.9% [4 of 31]), whereas treatment of those with intestinal histologic subtype was more varied (fluorouracil, 50.0% [17 of 34]; gemcitabine, 44.1% [15 of 34]; P =.01). In the propensity score-matched cohort, AT was not associated with a survival benefit for either histologic subtype (intestinal: hazard ratio, 1.21; 95% CI, 0.67-2.16; P =.53; pancreatobiliary: hazard ratio, 1.35; 95% CI, 0.66-2.76; P =.41). Conclusions and Relevance: Adjuvant therapy was more frequently used in patients with poor prognostic factors but was not associated with demonstrable improvements in survival, regardless of tumor histologic subtype. The value of a multimodality regimen remains poorly defined..
AB - Importance: Ampullary adenocarcinoma is a rare malignant neoplasm that arises within the duodenal ampullary complex. The role of adjuvant therapy (AT) in the treatment of ampullary adenocarcinoma has not been clearly defined. Objective: To determine if long-term survival after curative-intent resection of ampullary adenocarcinoma may be improved by selection of patients for AT directed by histologic subtype. Design, Setting, and Participants: This multinational, retrospective cohort study was conducted at 12 institutions from April 1, 2000, to July 31, 2017, among 357 patients with resected, nonmetastatic ampullary adenocarcinoma receiving surgery alone or AT. Cox proportional hazards regression was used to identify covariates associated with overall survival. The surgery alone and AT cohorts were matched 1:1 by propensity scores based on the likelihood of receiving AT or by survival hazard from Cox modeling. Overall survival was compared with Kaplan-Meier estimates. Exposures: Adjuvant chemotherapy (fluorouracil- or gemcitabine-based) with or without radiotherapy. Main Outcomes and Measures: Overall survival. Results: A total of 357 patients (156 women and 201 men; median age, 65.8 years [interquartile range, 58-74 years]) underwent curative-intent resection of ampullary adenocarcinoma. Patients with intestinal subtype had a longer median overall survival compared with those with pancreatobiliary subtype (77 vs 54 months; P =.05). Histologic subtype was not associated with AT administration (intestinal, 52.9% [101 of 191]; and pancreatobiliary, 59.5% [78 of 131]; P =.24). Patients with pancreatobiliary histologic subtype most commonly received gemcitabine-based regimens (71.0% [22 of 31]) or combinations of gemcitabine and fluorouracil (12.9% [4 of 31]), whereas treatment of those with intestinal histologic subtype was more varied (fluorouracil, 50.0% [17 of 34]; gemcitabine, 44.1% [15 of 34]; P =.01). In the propensity score-matched cohort, AT was not associated with a survival benefit for either histologic subtype (intestinal: hazard ratio, 1.21; 95% CI, 0.67-2.16; P =.53; pancreatobiliary: hazard ratio, 1.35; 95% CI, 0.66-2.76; P =.41). Conclusions and Relevance: Adjuvant therapy was more frequently used in patients with poor prognostic factors but was not associated with demonstrable improvements in survival, regardless of tumor histologic subtype. The value of a multimodality regimen remains poorly defined..
UR - http://www.scopus.com/inward/record.url?scp=85066466129&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85066466129&partnerID=8YFLogxK
U2 - 10.1001/jamasurg.2019.1170
DO - 10.1001/jamasurg.2019.1170
M3 - Article
C2 - 31141112
AN - SCOPUS:85066466129
JO - JAMA Surgery
JF - JAMA Surgery
SN - 2168-6254
ER -