Cecilia G Ethun1, Alexandra G Lopez-Aguiar1, Timothy M Pawlik2, George Poultsides3, Kamran Idrees4, Ryan C Fields5, Sharon M Weber6, Clifford Cho6, Robert C Martin7, Charles R Scoggins7, Perry Shen8, Carl Schmidt9, Ioannis Hatzaras10, David Bentrem11, Syed Ahmad12, Daniel Abbott13, Hong Jin Kim14, Nipun Merchant15, Charles A Staley1, David A Kooby1, Shishir K Maithel16. 1. Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA. 2. Division of Surgical Oncology, Department of Surgery, Johns Hopkins University, Baltimore, MD; Division of Surgical Oncology, Department of Surgery, The Ohio State University, Columbus, OH. 3. Department of Surgery, Stanford University, Stanford, CA. 4. Division of Surgical Oncology, Department of Surgery, Vanderbilt University, Nashville, TN. 5. Department of Surgery, Washington University, St Louis, MO. 6. Department of Surgery, University of Wisconsin, Madison, WI. 7. Division of Surgical Oncology, Department of Surgery, University of Louisville, Louisville, KY. 8. Department of Surgery, Wake Forest University, Winston-Salem, NC. 9. Division of Surgical Oncology, Department of Surgery, The Ohio State University, Columbus, OH. 10. Department of Surgery, New York University, New York, NY. 11. Department of Surgery, Northwestern University, Chicago, IL. 12. Division of Surgical Oncology, Department of Surgery, University of Cincinnati, Cincinnati, OH. 13. Division of Surgical Oncology, Department of Surgery, University of Cincinnati, Cincinnati, OH; Department of Surgery, University of Wisconsin, Madison, WI. 14. Division of Surgical Oncology, Department of Surgery, University of North Carolina, Raleigh, NC. 15. Division of Surgical Oncology, Department of Surgery, Vanderbilt University, Nashville, TN; Division of Surgical Oncology, Department of Surgery, University of Miami, Miami, FL. 16. Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA. Electronic address: smaithe@emory.edu.
Abstract
BACKGROUND: Distal cholangiocarcinoma (DC) and pancreatic ductal adenocarcinoma (PDAC) are often managed as 1 entity, yet direct comparisons are lacking. Our aim was to use 2 large multi-institutional databases to assess treatment, pathologic, and survival differences between these diseases. STUDY DESIGN: This study included patients with DC and PDAC who underwent curative-intent pancreaticoduodenectomy from 2000 to 2015 at 13 institutions comprising the US Extrahepatic Biliary Malignancy and Central Pancreas Consortiums. Primary endpoint was disease-specific survival (DSS). RESULTS: Of 1,463 patients, 224 (15%) had DC and 1,239 (85%) had PDAC. Compared with PDAC, DC patients were less likely to be margin-positive (19% vs 25%; p = 0.005), lymph node (LN)-positive (55% vs 69%; p < 0.001), and receive adjuvant therapy (57% vs 71%; p < 0.001). Of DC patients treated with adjuvant therapy, 62% got gemcitabine alone and 16% got gemcitabine/cisplatin. Distal cholangiocarcinoma was associated with improved median DSS (40 months) compared with PDAC (22 months; p < 0.001), which persisted on multivariable analysis (hazard ratio 0.65; 95% CI 0.50 to 0.84; p = 0.001). Lymph node involvement was the only factor independently associated with decreased DSS for both DC and PDAC. The DC/LN-positive patients had similar DSS as PDAC/LN-negative patients (p = 0.74). Adjuvant therapy (chemotherapy ± radiation) was associated with improved median DSS for PDAC/LN-positive patients (21 vs 13 months; p = 0.001), but not for DC patients (38 vs 40 months; p = 0.62), regardless of LN status. CONCLUSIONS: Distal cholangiocarcinoma and pancreatic ductal adenocarcinoma are distinct entities. Distal cholangiocarcinoma has a favorable prognosis compared with PDAC, yet current adjuvant therapy regimens are only associated with improved survival in PDAC, not DC. Therefore, treatment paradigms used for PDAC should not be extrapolated to DC, despite similar operative approaches, and novel therapies for DC should be explored.
BACKGROUND: Distal cholangiocarcinoma (DC) and pancreatic ductal adenocarcinoma (PDAC) are often managed as 1 entity, yet direct comparisons are lacking. Our aim was to use 2 large multi-institutional databases to assess treatment, pathologic, and survival differences between these diseases. STUDY DESIGN: This study included patients with DC and PDAC who underwent curative-intent pancreaticoduodenectomy from 2000 to 2015 at 13 institutions comprising the US Extrahepatic Biliary Malignancy and Central Pancreas Consortiums. Primary endpoint was disease-specific survival (DSS). RESULTS: Of 1,463 patients, 224 (15%) had DC and 1,239 (85%) had PDAC. Compared with PDAC, DCpatients were less likely to be margin-positive (19% vs 25%; p = 0.005), lymph node (LN)-positive (55% vs 69%; p < 0.001), and receive adjuvant therapy (57% vs 71%; p < 0.001). Of DCpatients treated with adjuvant therapy, 62% got gemcitabine alone and 16% got gemcitabine/cisplatin. Distal cholangiocarcinoma was associated with improved median DSS (40 months) compared with PDAC (22 months; p < 0.001), which persisted on multivariable analysis (hazard ratio 0.65; 95% CI 0.50 to 0.84; p = 0.001). Lymph node involvement was the only factor independently associated with decreased DSS for both DC and PDAC. The DC/LN-positive patients had similar DSS as PDAC/LN-negative patients (p = 0.74). Adjuvant therapy (chemotherapy ± radiation) was associated with improved median DSS for PDAC/LN-positive patients (21 vs 13 months; p = 0.001), but not for DCpatients (38 vs 40 months; p = 0.62), regardless of LN status. CONCLUSIONS: Distal cholangiocarcinoma and pancreatic ductal adenocarcinoma are distinct entities. Distal cholangiocarcinoma has a favorable prognosis compared with PDAC, yet current adjuvant therapy regimens are only associated with improved survival in PDAC, not DC. Therefore, treatment paradigms used for PDAC should not be extrapolated to DC, despite similar operative approaches, and novel therapies for DC should be explored.
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Authors: Lenka N C Boyd; Mahsoem Ali; Laura Kam; Jisce R Puik; Stephanie M Fraga Rodrigues; Eline S Zwart; Freek Daams; Barbara M Zonderhuis; Laura L Meijer; Tessa Y S Le Large; Elisa Giovannetti; Hanneke W M van Laarhoven; Geert Kazemier Journal: Cancers (Basel) Date: 2022-01-11 Impact factor: 6.639