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.
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.
Authors: John T Miura; Thejus T Jayakrishnan; Albert Amini; Fabian M Johnston; Susan Tsai; Beth Erickson; Edward J Quebbeman; Kathleen K Christians; Douglas B Evans; T Clark Gamblin; Kiran K Turaga Journal: J Gastrointest Surg Date: 2014-08-27 Impact factor: 3.452
Authors: Brett L Ecker; Matthew T McMillan; Laura Maggino; Valentina Allegrini; Horacio J Asbun; Chad G Ball; Claudio Bassi; Joal D Beane; Stephen W Behrman; Adam C Berger; Mark Bloomston; Mark P Callery; John D Christein; Euan Dickson; Elijah Dixon; Jeffrey A Drebin; Carlos Fernandez-Del Castillo; William E Fisher; Zhi Ven Fong; Ericka Haverick; Robert H Hollis; Michael G House; Steven J Hughes; Nigel B Jamieson; Tara S Kent; Stacy J Kowalsky; John W Kunstman; Giuseppe Malleo; Ronald R Salem; Kevin C Soares; Vicente Valero; Ammara A Watkins; Christopher L Wolfgang; Amer H Zureikat; Charles M Vollmer Journal: J Gastrointest Surg Date: 2017-08-24 Impact factor: 3.452
Authors: Pierre-Emmanuel Robert; Christophe Leux; Mehdi Ouaissi; Mathieu Miguet; François Paye; Aude Merdrignac; Jean Robert Delpero; Lilian Schwarz; Nicolas Carrere; Fabrice Muscari; Brice Gayet; David Dussart; Antoine Hamy; Nicolas Regenet Journal: Pancreas Date: 2014-07 Impact factor: 3.327
Authors: John P Neoptolemos; Malcolm J Moore; Trevor F Cox; Juan W Valle; Daniel H Palmer; Alexander C McDonald; Ross Carter; Niall C Tebbutt; Christos Dervenis; David Smith; Bengt Glimelius; Richard M Charnley; François Lacaine; Andrew G Scarfe; Mark R Middleton; Alan Anthoney; Paula Ghaneh; Christopher M Halloran; Markus M Lerch; Attila Oláh; Charlotte L Rawcliffe; Caroline S Verbeke; Fiona Campbell; Markus W Büchler Journal: JAMA Date: 2012-07-11 Impact factor: 56.272
Authors: Saptarshi Chakraborty; Brett L Ecker; Mithat Gonen; Ronglai Shen; William R Jarnagin; Ken Seier; Victoria G Aveson; Vinod P Balachandran; Jeffrey A Drebin; Michael I D'Angelica; T Peter Kingham; Carlie S Sigel; Kevin C Soares; Efsevia Vakiani; Alice C Wei; Rohit Chandwani Journal: Clin Cancer Res Date: 2021-08-25 Impact factor: 12.531