Neoadjuvant Therapy Versus Upfront Resection for Nonpancreatic Periampullary Adenocarcinoma.
Journal
Annals of surgical oncology
ISSN: 1534-4681
Titre abrégé: Ann Surg Oncol
Pays: United States
ID NLM: 9420840
Informations de publication
Date de publication:
Jan 2023
Jan 2023
Historique:
received:
03
01
2022
accepted:
30
05
2022
pubmed:
5
8
2022
medline:
15
12
2022
entrez:
4
8
2022
Statut:
ppublish
Résumé
In contrast to pancreatic ductal adenocarcinoma (PDAC), neoadjuvant therapy (NAT) for periampullary adenocarcinomas is not well studied, with data limited to single-institution retrospective reviews with small cohorts. We sought to compare outcomes of NAT versus upfront resection (UR) for non-PDAC periampullary adenocarcinomas. Using the National Cancer Database (NCDB), we identified patients who underwent surgery for extrahepatic cholangiocarcinoma, ampullary adenocarcinoma, or duodenal adenocarcinoma from 2006 to 2016. We compared outcomes between NAT versus UR groups for each tumor subtype with 1:3 propensity score matching. Cox regression was used to identify predictors of survival. Among 7656 patients who underwent resection for non-PDAC periampullary adenocarcinoma, the proportion of patients who received NAT increased from 6 to 11% for cholangiocarcinoma (p < 0.01), 1 to 4% for ampullary adenocarcinoma (p = 0.01), and 5 to 8% for duodenal adenocarcinoma (p = 0.08). Length of stay, readmission, and 30-day mortality were comparable between NAT and UR. All tumor subtypes were downstaged following NAT (p < 0.01). The R0 resection rate was significantly higher in patients with extrahepatic cholangiocarcinoma who received NAT, and these patients had improved median overall survival (38 vs 26 months, p < 0.001). After adjustment for clinicopathologic factors and adjuvant chemotherapy, use of NAT was associated with improved survival in patients with cholangiocarcinoma [hazard ratio (HR) 0.69, 95% confidence interval (CI) 0.54-0.89, p = 0.004] but not duodenal or ampullary adenocarcinoma. The survival advantage for cholangiocarcinoma persisted after propensity matching. This national cohort analysis suggests, for the first time, that neoadjuvant therapy is associated with improved survival in patients with extrahepatic cholangiocarcinoma.
Sections du résumé
BACKGROUND
BACKGROUND
In contrast to pancreatic ductal adenocarcinoma (PDAC), neoadjuvant therapy (NAT) for periampullary adenocarcinomas is not well studied, with data limited to single-institution retrospective reviews with small cohorts. We sought to compare outcomes of NAT versus upfront resection (UR) for non-PDAC periampullary adenocarcinomas.
PATIENTS AND METHODS
METHODS
Using the National Cancer Database (NCDB), we identified patients who underwent surgery for extrahepatic cholangiocarcinoma, ampullary adenocarcinoma, or duodenal adenocarcinoma from 2006 to 2016. We compared outcomes between NAT versus UR groups for each tumor subtype with 1:3 propensity score matching. Cox regression was used to identify predictors of survival.
RESULTS
RESULTS
Among 7656 patients who underwent resection for non-PDAC periampullary adenocarcinoma, the proportion of patients who received NAT increased from 6 to 11% for cholangiocarcinoma (p < 0.01), 1 to 4% for ampullary adenocarcinoma (p = 0.01), and 5 to 8% for duodenal adenocarcinoma (p = 0.08). Length of stay, readmission, and 30-day mortality were comparable between NAT and UR. All tumor subtypes were downstaged following NAT (p < 0.01). The R0 resection rate was significantly higher in patients with extrahepatic cholangiocarcinoma who received NAT, and these patients had improved median overall survival (38 vs 26 months, p < 0.001). After adjustment for clinicopathologic factors and adjuvant chemotherapy, use of NAT was associated with improved survival in patients with cholangiocarcinoma [hazard ratio (HR) 0.69, 95% confidence interval (CI) 0.54-0.89, p = 0.004] but not duodenal or ampullary adenocarcinoma. The survival advantage for cholangiocarcinoma persisted after propensity matching.
CONCLUSION
CONCLUSIONS
This national cohort analysis suggests, for the first time, that neoadjuvant therapy is associated with improved survival in patients with extrahepatic cholangiocarcinoma.
Identifiants
pubmed: 35925536
doi: 10.1245/s10434-022-12257-x
pii: 10.1245/s10434-022-12257-x
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
165-174Commentaires et corrections
Type : CommentIn
Type : CommentIn
Informations de copyright
© 2022. This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.
Références
Palta M, et al. Carcinoma of the ampulla of Vater: patterns of failure following resection and benefit of chemoradiotherapy. Ann Surg Oncol. 2012;19(5):1535–40. https://doi.org/10.1245/s10434-011-2117-1 .
doi: 10.1245/s10434-011-2117-1
Bakaeen FG, et al. What prognostic factors are important in duodenal adenocarcinoma? Arch Surg. 2000;135(6):635–42.
doi: 10.1001/archsurg.135.6.635
Veillette G, Castillo CF. Distal biliary malignancy. Surg Clin N Am. 2008;88(6):1429–47.
doi: 10.1016/j.suc.2008.07.003
Doepker MP, et al. Clinicopathologic and survival analysis of resected ampullary adenocarcinoma. J Surg Oncol. 2016;114(2):170–5.
doi: 10.1002/jso.24281
Albores-Saavedra J, et al. Cancers of the ampulla of vater: demographics, morphology, and survival based on 5,625 cases from the SEER program. J Surg Oncol. 2009;100(7):598–605.
doi: 10.1002/jso.21374
Hester CA, et al. Incidence and comparative outcomes of periampullary cancer: a population-based analysis demonstrating improved outcomes and increased use of adjuvant therapy from 2004 to 2012. J Surg Oncol. 2019;119(3):303–17.
doi: 10.1002/jso.25336
Chawla A, et al. Neoadjuvant therapy is associated with improved survival in borderline-resectable pancreatic cancer. Ann Surg Oncol. 2020;27(4):1191–200. https://doi.org/10.1245/s10434-019-08087-z .
doi: 10.1245/s10434-019-08087-z
Oba A, et al. Neoadjuvant treatment in pancreatic cancer. Front Oncol. 2020;10:245.
doi: 10.3389/fonc.2020.00245
Khorana AA, et al. Potentially curable pancreatic cancer: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol. 2017;35(20):2324–8.
doi: 10.1200/JCO.2017.72.4948
Adam M, et al. Neoadjuvant chemotherapy for pancreatic adenocarcinoms lessens the deleterious effect of omission of adjuvant chemotherapy. Ann Surg Oncol. 2021;28:3800–7. https://doi.org/10.1245/s10434-020-09446-x .
doi: 10.1245/s10434-020-09446-x
Neoptolemos JP, et al. Effect of adjuvant chemotherapy with fluorouracil plus folinic acid or gemcitabine vs observation on survival in patients with resected periampullary adenocarcinoma: the ESPAC-3 periampullary cancer randomized trial. JAMA. 2012;308(2):147–56.
doi: 10.1001/jama.2012.7352
Neoptolemos JP, et al. Comparison of adjuvant gemcitabine and capecitabine with gemcitabine monotherapy in patients with resected pancreatic cancer (ESPAC-4): a multicentre, open-label, randomised, phase 3 trial. Lancet. 2017;389(10073):1011–24.
doi: 10.1016/S0140-6736(16)32409-6
Primrose JN, et al. Capecitabine compared with observation in resected biliary tract cancer (BILCAP): a randomised, controlled, multicentre, phase 3 study. Lancet Oncol. 2019;20(5):663–73.
doi: 10.1016/S1470-2045(18)30915-X
Cloyd JM, et al. The role of preoperative therapy prior to pancreatoduodenectomy for distal cholangiocarcinoma. Am J Surg. 2019;218(1):145–50.
doi: 10.1016/j.amjsurg.2018.08.024
McMasters KM, et al. Neoadjuvant chemoradiation for extrahepatic cholangiocarcinoma. Am J Surg. 1997;174(6):605–8 (discussion 608-9).
doi: 10.1016/S0002-9610(97)00203-1
Nelson JW, et al. Concurrent chemoradiotherapy in resected extrahepatic cholangiocarcinoma. Int J Radiat Oncol Biol Phys. 2009;73(1):148–53.
doi: 10.1016/j.ijrobp.2008.07.008
Meijer LL, et al. Outcomes and treatment options for duodenal adenocarcinoma: a systematic review and meta-analysis. Ann Surg Oncol. 2018;25(9):2681–92. https://doi.org/10.1245/s10434-018-6567-6 .
doi: 10.1245/s10434-018-6567-6
Yi SW, et al. Efficacy of concurrent chemoradiotherapy with 5-fluorouracil or gemcitabine in locally advanced biliary tract cancer. Cancer Chemother Pharmacol. 2014;73(1):191–8.
doi: 10.1007/s00280-013-2340-5
Kato A, et al. Surgical resection after downsizing chemotherapy for initially unresectable locally advanced biliary tract cancer: a retrospective single-center study. Ann Surg Oncol. 2013;20(1):318–24. https://doi.org/10.1245/s10434-012-2312-8 .
doi: 10.1245/s10434-012-2312-8
Yeung RS, et al. Neoadjuvant chemoradiation in pancreatic and duodenal carcinoma. A phase II study. Cancer. 1993;72(7):2124–33.
doi: 10.1002/1097-0142(19931001)72:7<2124::AID-CNCR2820720711>3.0.CO;2-C
Onkendi EO, et al. Neoadjuvant treatment of duodenal adenocarcinoma: a rescue strategy. J Gastrointest Surg. 2012;16(2):320–4.
doi: 10.1007/s11605-011-1667-7
Kelsey CR, et al. Duodenal adenocarcinoma: patterns of failure after resection and the role of chemoradiotherapy. Int J Radiat Oncol Biol Phys. 2007;69(5):1436–41.
doi: 10.1016/j.ijrobp.2007.05.006
Rose DM, et al. Primary duodenal adenocarcinoma: a ten-year experience with 79 patients. J Am Coll Surg. 1996;183(2):89–96.
Linden K, et al. The role of neoadjuvant versus adjuvant therapy for duodenal adenocarcinoma: a national cancer database propensity score matched analysis. Am Surg. 2020;87:1066–73.
doi: 10.1177/0003134820954821
Cloyd JM, et al. Influence of preoperative therapy on short- and long-term outcomes of patients with adenocarcinoma of the ampulla of Vater. Ann Surg Oncol. 2017;24(7):2031–9. https://doi.org/10.1245/s10434-017-5777-7 .
doi: 10.1245/s10434-017-5777-7
Hatzaras I, et al. Predictors of survival in periampullary cancers following pancreaticoduodenectomy. Ann Surg Oncol. 2010;17(4):991–7. https://doi.org/10.1245/s10434-009-0883-9 .
doi: 10.1245/s10434-009-0883-9
Mehta VK, et al. Adjuvant chemoradiotherapy for “unfavorable” carcinoma of the ampulla of Vater: preliminary report. Arch Surg. 2001;136(1):65–9.
doi: 10.1001/archsurg.136.1.65
Kwon J, et al. Survival benefit of adjuvant chemoradiotherapy in patients with ampulla of vater cancer: a systematic review and meta-analysis. Ann Surg. 2015;262(1):47–52.
doi: 10.1097/SLA.0000000000001182
Xia BT, et al. Early recurrence and omission of adjuvant therapy after pancreaticoduodenectomy argue against a surgery-first approach. Ann Surg Oncol. 2016;23(13):4156–64. https://doi.org/10.1245/s10434-016-5457-z .
doi: 10.1245/s10434-016-5457-z