Association of Adjuvant Therapy with Improved Survival in Ampullary Cancer: A National Cohort Study

Ibrahim Nassour, Linda S. Hynan, Alana Christie, Rebecca M. Minter, Adam C. Yopp, Michael A. Choti, John C. Mansour, Matthew R. Porembka, Sam C. Wang

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background: There are limited data on the efficacy of adjuvant therapy in ampullary cancer. The aim of this study was to determine whether adjuvant therapy was associated with improved survival for patients with ampullary cancer. Methods: From the National Cancer Database, we identified ampullary cancer patients who underwent resection between 2004 and 2013. We performed 1:1 propensity score matching, comparing patients who had postoperative observation to patients who received adjuvant chemotherapy (ACT) or adjuvant chemoradiotherapy (ACRT). Results: We identified 4190 patients who fit our inclusion criteria; 63% had postoperative observation, 21% received ACT, and 16% underwent ACRT. In the matched cohorts, the use of ACT was associated with improved overall survival (HR = 0.82, 95% CI = 0.71 to 0.95). The median overall survival was 47.2 months for the ACT group and 35.5 months for the observation group. In a separate matched analysis, ACRT was also associated with improved survival (HR = 0.84, 95% CI = 0.72 to 0.98) as compared to observation. The median overall survival was 38.1 months for the ACRT group and 31.0 months for the observation group. The benefit was more pronounced in high-risk patients, such as ones with higher T and N categories. Conclusions: In this retrospective study, the use of adjuvant therapy in ampullary cancer was associated with significantly improved overall survival. The benefit of adjuvant therapy for this disease should be confirmed in a more rigorous fashion via randomized controlled trials.

Original languageEnglish (US)
Pages (from-to)1-8
Number of pages8
JournalJournal of Gastrointestinal Surgery
DOIs
StateAccepted/In press - Nov 10 2017

Fingerprint

Adjuvant Chemoradiotherapy
Cohort Studies
Adjuvant Chemotherapy
Observation
Survival
Neoplasms
Therapeutics
Propensity Score
Randomized Controlled Trials
Retrospective Studies
Databases

Keywords

  • Adjuvant therapy
  • Ampullary cancer
  • Ampullary carcinoma
  • Chemoradiation
  • Chemotherapy

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology

Cite this

Association of Adjuvant Therapy with Improved Survival in Ampullary Cancer : A National Cohort Study. / Nassour, Ibrahim; Hynan, Linda S.; Christie, Alana; Minter, Rebecca M.; Yopp, Adam C.; Choti, Michael A.; Mansour, John C.; Porembka, Matthew R.; Wang, Sam C.

In: Journal of Gastrointestinal Surgery, 10.11.2017, p. 1-8.

Research output: Contribution to journalArticle

@article{fc281ea7cee04aab99c577b813d7218a,
title = "Association of Adjuvant Therapy with Improved Survival in Ampullary Cancer: A National Cohort Study",
abstract = "Background: There are limited data on the efficacy of adjuvant therapy in ampullary cancer. The aim of this study was to determine whether adjuvant therapy was associated with improved survival for patients with ampullary cancer. Methods: From the National Cancer Database, we identified ampullary cancer patients who underwent resection between 2004 and 2013. We performed 1:1 propensity score matching, comparing patients who had postoperative observation to patients who received adjuvant chemotherapy (ACT) or adjuvant chemoradiotherapy (ACRT). Results: We identified 4190 patients who fit our inclusion criteria; 63{\%} had postoperative observation, 21{\%} received ACT, and 16{\%} underwent ACRT. In the matched cohorts, the use of ACT was associated with improved overall survival (HR = 0.82, 95{\%} CI = 0.71 to 0.95). The median overall survival was 47.2 months for the ACT group and 35.5 months for the observation group. In a separate matched analysis, ACRT was also associated with improved survival (HR = 0.84, 95{\%} CI = 0.72 to 0.98) as compared to observation. The median overall survival was 38.1 months for the ACRT group and 31.0 months for the observation group. The benefit was more pronounced in high-risk patients, such as ones with higher T and N categories. Conclusions: In this retrospective study, the use of adjuvant therapy in ampullary cancer was associated with significantly improved overall survival. The benefit of adjuvant therapy for this disease should be confirmed in a more rigorous fashion via randomized controlled trials.",
keywords = "Adjuvant therapy, Ampullary cancer, Ampullary carcinoma, Chemoradiation, Chemotherapy",
author = "Ibrahim Nassour and Hynan, {Linda S.} and Alana Christie and Minter, {Rebecca M.} and Yopp, {Adam C.} and Choti, {Michael A.} and Mansour, {John C.} and Porembka, {Matthew R.} and Wang, {Sam C.}",
year = "2017",
month = "11",
day = "10",
doi = "10.1007/s11605-017-3624-6",
language = "English (US)",
pages = "1--8",
journal = "Journal of Gastrointestinal Surgery",
issn = "1091-255X",
publisher = "Springer New York",

}

TY - JOUR

T1 - Association of Adjuvant Therapy with Improved Survival in Ampullary Cancer

T2 - A National Cohort Study

AU - Nassour, Ibrahim

AU - Hynan, Linda S.

AU - Christie, Alana

AU - Minter, Rebecca M.

AU - Yopp, Adam C.

AU - Choti, Michael A.

AU - Mansour, John C.

AU - Porembka, Matthew R.

AU - Wang, Sam C.

PY - 2017/11/10

Y1 - 2017/11/10

N2 - Background: There are limited data on the efficacy of adjuvant therapy in ampullary cancer. The aim of this study was to determine whether adjuvant therapy was associated with improved survival for patients with ampullary cancer. Methods: From the National Cancer Database, we identified ampullary cancer patients who underwent resection between 2004 and 2013. We performed 1:1 propensity score matching, comparing patients who had postoperative observation to patients who received adjuvant chemotherapy (ACT) or adjuvant chemoradiotherapy (ACRT). Results: We identified 4190 patients who fit our inclusion criteria; 63% had postoperative observation, 21% received ACT, and 16% underwent ACRT. In the matched cohorts, the use of ACT was associated with improved overall survival (HR = 0.82, 95% CI = 0.71 to 0.95). The median overall survival was 47.2 months for the ACT group and 35.5 months for the observation group. In a separate matched analysis, ACRT was also associated with improved survival (HR = 0.84, 95% CI = 0.72 to 0.98) as compared to observation. The median overall survival was 38.1 months for the ACRT group and 31.0 months for the observation group. The benefit was more pronounced in high-risk patients, such as ones with higher T and N categories. Conclusions: In this retrospective study, the use of adjuvant therapy in ampullary cancer was associated with significantly improved overall survival. The benefit of adjuvant therapy for this disease should be confirmed in a more rigorous fashion via randomized controlled trials.

AB - Background: There are limited data on the efficacy of adjuvant therapy in ampullary cancer. The aim of this study was to determine whether adjuvant therapy was associated with improved survival for patients with ampullary cancer. Methods: From the National Cancer Database, we identified ampullary cancer patients who underwent resection between 2004 and 2013. We performed 1:1 propensity score matching, comparing patients who had postoperative observation to patients who received adjuvant chemotherapy (ACT) or adjuvant chemoradiotherapy (ACRT). Results: We identified 4190 patients who fit our inclusion criteria; 63% had postoperative observation, 21% received ACT, and 16% underwent ACRT. In the matched cohorts, the use of ACT was associated with improved overall survival (HR = 0.82, 95% CI = 0.71 to 0.95). The median overall survival was 47.2 months for the ACT group and 35.5 months for the observation group. In a separate matched analysis, ACRT was also associated with improved survival (HR = 0.84, 95% CI = 0.72 to 0.98) as compared to observation. The median overall survival was 38.1 months for the ACRT group and 31.0 months for the observation group. The benefit was more pronounced in high-risk patients, such as ones with higher T and N categories. Conclusions: In this retrospective study, the use of adjuvant therapy in ampullary cancer was associated with significantly improved overall survival. The benefit of adjuvant therapy for this disease should be confirmed in a more rigorous fashion via randomized controlled trials.

KW - Adjuvant therapy

KW - Ampullary cancer

KW - Ampullary carcinoma

KW - Chemoradiation

KW - Chemotherapy

UR - http://www.scopus.com/inward/record.url?scp=85033465330&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85033465330&partnerID=8YFLogxK

U2 - 10.1007/s11605-017-3624-6

DO - 10.1007/s11605-017-3624-6

M3 - Article

C2 - 29127604

AN - SCOPUS:85033465330

SP - 1

EP - 8

JO - Journal of Gastrointestinal Surgery

JF - Journal of Gastrointestinal Surgery

SN - 1091-255X

ER -