Neoadjuvant chemotherapy versus upfront resection in ampullary adenocarcinoma stratified by stage: A retrospective analysis using the national cancer database
Leonard-Murali S, Shah R, Ivanics T, Han X, Steffes CP, and Kwon DS. Neoadjuvant chemotherapy versus upfront resection in ampullary adenocarcinoma stratified by stage: A retrospective analysis using the national cancer database. Ann Surg Oncol 2019; 26(Suppl 1):S136.
Ann Surg Oncol
Outcomes of a neoadjuvant therapy (NAT) strategy to treat ampullary adenocarcinoma (AAC) are not clear. Upfront resection (UR) (typically pancreaticoduodenectomy) with or without adjuvant therapy (AT) is currently the standard of care. We looked to assess outcomes of NAT followed by radical surgery for AAC. Methods: The NCDB was queried for ampullary carcinoma patients from 2004-2015. Patients with Stage 1 to 111 AAC who underwent radical surgery were included, and separated into NAT with surgery and UR groups. Demographic/clinical/pathologic data and their associations to survival were analyzed with univariate and multivariate cox proportional hazard models. Overall survival was estimated from time of diagnosis using Kaplan-Meier curves and compared using log-rank tests (LRT) (see Figure 1). Statistical analyses were performed using R version 3.5.1 with significance established at p<0.05. Results: There was no difference in overall survival between the NAT (n = 47) and UR (n = 1521) groups, either as total groups (LRT p=0.2), or when stratified by stage (stratified LRT p=0.5). Rates of AT were higher in the UR group (p=0.038). Receiving AT was significantly associated with improved survival (hazard ratio (HR) = 0.648), while positive nodal status (HR = 2.06), stage 3 disease (HR = 1.542), age>65 (HR = 1.494), and male gender (HR = 1.241) were all significantly associated with decreased overall survival by multivariate analysis. Conclusions: NAT does not offer a survival advantage over UR either overall or for stage-specific disease. This finding extended even to stage III disease, where NAT would theoretically offer greatest benefit. This study suggests that a NAT strategy is not preferable to UR for treatment of resectable AAC, regardless of stage. Higher powered study of NAT for AAC with controls for AT is warranted before discarding a NAT strategy.