Ampullary carcinoma is a rare gastrointestinal cancer and the benefit of adjuvant chemotherapy is debatable. We used the National Cancer Data Base (NCDB) to evaluate if adjuvant chemotherapy (AC) or adjuvant chemo-radiation (ACR) provides a survival benefit in patients undergoing resection.
Utilizing the NCDB from 2004-2012, 5949 patients who underwent ampullary tumor resection were identified. All patients had confirmed histological diagnosis, and follow up. Patients not considered candidates for AC or ACR were excluded. 2194 patients underwent surgical resection alone (S). This cohort was compared with 874 patients who received AC, and 1128 patients ACR. Patients were stratified into node negative (NN) or node positive (NP) disease. Overall survival (OS) was performed utilizing Kaplan-Meier method, and log-rank tests were used for statistical comparisons. Cox proportional hazards were performed to control for age, gender, race, type of facility (academic versus non-academic), income, education, Charlson-Deyo score (CDS), T size, and histologic grade. All tests were two sided and a P value of
The median age at diagnosis was 65 years (range 20-90). In the NN group, median OS was not reached (NR) for AC, NR for ACR and 101 months (mo) for S (p = 0.21). In contrast in the NP group, median OS was 33 mo for AC, 35 mo for ACR and 27 mo for S (p
Adjuvant chemotherapy or chemoradiotherapy are associated with a significant survival benefit in patients with resected node positive ampullary carcinoma when compared to surgery alone. The addition of radiation, however, does not confer additional benefit over adjuvant chemotherapy. Patients with node negative disease do not seem to benefit from adjuvant therapy regardless of primary tumor size.
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All authors have declared no conflicts of interest.