Abstract 310P
Background
Periampullary carcinoma (PA Ca) management data is limited in LMIC countries. Our multicentric retrospective study examines care patterns and outcomes in the Indian Subcontinent.
Methods
Conducted at four tertiary cancer care sites in India from January 2019 to December 2023, our study, after ethical review, retrieved patient data. The aim was to explore PA Ca care patterns and outcomes. Analysis utilized SPSS Statistics (Version 23.0).
Results
We enrolled 95 patients with a median age of 56, comprising 56 males (59%) and 39 females (41%). Alcohol and smoking were reported in 17% and 15%, respectively. Diabetes (33%) and hypertension (24%) were common comorbidities. Jaundice and abdominal pain were common presentations (69.7% and 61.7%, respectively). Mean total and direct bilirubin levels were 7.8mg/dl and 4.5mg/dl, respectively. The mean CA19.9 and CEA levels were 1034mg/dl and 3.74mg/dl. Early-stage disease was observed in 78%, with 22% presenting with metastasis. The most common disease location was the ampullary region (48%). Sixty-five patients underwent upfront surgery, while two received neoadjuvant chemotherapy. After surgery, 97% achieved R0 resection, with pathological T2 and T3 in 46% and 40%, respectively. The most common histological subtype was pancreatic adenocarcinoma (53%). Among the R0 resection group, median DFS was not reached (3-year DFS: 62.7% and 2-year DFS: 80.6%). For R1 resection and metastatic disease, median PFS was 17 months (95% CI: 8-26 months), with median overall survival not reached. Table: 310P
Characteristics
| n | % | |
| Site of tumour | n=95 | |
| Ampullary | 44 | 46.3 |
| Head of pancreas | 33 | 34.7 |
| Distal CBD | 10 | 10.5 |
| Duodenal | 8 | 8.4 |
| Stage | ||
| IA | 5 | 5.2 |
| IB | 29 | 30.5 |
| IIA | 10 | 10.5 |
| II | 13 | 13.6 |
| IIIA | 12 | 12.6 |
| IIIB | 5 | 5.2 |
| IV | 21 | 22.1 |
| Histology | n=93 | |
| Adenocarcinoma | 61 | 65.5 |
| Intestinal | 18 | 19.3 |
| Pancreaticobiliary | 14 | 15.0 |
| Type of chemotherapy | n=77 | |
| Adjuvant | 55 | 71.4 |
| Palliative | 20 | 25.9 |
| Neoadjuvant | 2 | 2.5 |
| Regimen | n=61 | |
| 5-FU+GEM based only | 17 | 27.8 |
| GEM based only | 18 | 28.5 |
| 5-FU based only | 26 | 42.6 |
| Survival | ||
| mDFS | Not reached | |
| 3yr DFS | 62.7% | |
| 2yr DFS | 80.6% | |
| mPFS | 17 months | 8-26 months,95%CI |
| mOS | Not reached |
Conclusions
In conclusion, our study underscores the favorable outcomes observed in early-stage resectable PA Ca, with mDFS not reached. First-line chemotherapy yielded a PFS of 17 months for residual or metastatic disease, while mOS was not reached. Further research is imperative to refine PA Ca management strategies and optimize outcomes.
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.