The road to tailored adjuvant chemotherapy for all four non-pancreatic periampullary cancers: An international multimethod cohort study

期刊论文
发表日期：

2024年5月28日

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Bas A. Uijterwijk,
Daniël H. Lemmers,
Michele Ghidini,
Johanna W. Wilmink,
Alberto Zaniboni,
Giuseppe Kito Fusai,
Alessandro Zerbi,
Bas Groot Koerkamp,
Misha Luyer,
Poya Ghorbani,
Roberto Salvia,
Steven White,
Benedetto Ielpo,
Brian K. P. Goh,
Ugo Boggi,
Geert Kazemier,
Michael G. House,
Vasileios K. Mavroeidis,
Bergthor Björnsson,
Michele Mazzola,
Mario Serradilla,
Dimitris Korkolis,
Adnan Alseidi,
Keith J. Roberts,
Zahir Soonawalla,
Patrick Pessaux,
William E. Fisher,
Sharnice Koek,
Tara S. Kent,
Miljana Vladimirov,
Louisa Bolm,
Nigel Jamieson,
Raffaele Dalla Valle,
Jorg Kleeff,
Alessandro Mazzotta,
Miguel Angel Suarez Muñoz,
Santiago Sánchez Cabús,
Chad G. Ball,
Adam C. Berger,
Clarissa Ferarri,
Marc G. Besselink,
Mohammed Abu Hilal

摘要

Background

Despite differences in tumour behaviour and characteristics between duodenal adenocarcinoma (DAC), the intestinal (AmpIT) and pancreatobiliary (AmpPB) subtype of ampullary adenocarcinoma and distal cholangiocarcinoma (dCCA), the effect of adjuvant chemotherapy (ACT) on these cancers, as well as the optimal ACT regimen, has not been comprehensively assessed. This study aims to assess the influence of tailored ACT on DAC, dCCA, AmpIT, and AmpPB.

Patients and methods

Patients after pancreatoduodenectomy for non-pancreatic periampullary adenocarcinoma were identified and collected from 36 tertiary centres between 2010 - 2021. Per non-pancreatic periampullary tumour type, the effect of adjuvant chemotherapy and the main relevant regimens of adjuvant chemotherapy were compared. The primary outcome was overall survival (OS).

Results

The study included a total of 2866 patients with DAC (n = 330), AmpIT (n = 765), AmpPB (n = 819), and dCCA (n = 952). Among them, 1329 received ACT, and 1537 did not. ACT was associated with significant improvement in OS for AmpPB (P = 0.004) and dCCA (P < 0.001). Moreover, for patients with dCCA, capecitabine mono ACT provided the greatest OS benefit compared to gemcitabine (P = 0.004) and gemcitabine – cisplatin (P = 0.001). For patients with AmpPB, no superior ACT regime was found (P > 0.226). ACT was not associated with improved OS for DAC and AmpIT (P = 0.113 and P = 0.445, respectively).

Discussion

Patients with resected AmpPB and dCCA appear to benefit from ACT. While the optimal ACT for AmpPB remains undetermined, it appears that dCCA shows the most favourable response to capecitabine monotherapy. Tailored adjuvant treatments are essential for enhancing prognosis across all four non-pancreatic periampullary adenocarcinomas.