Department of Surgery, Division of Surgical Oncology, University of Texas Southwestern Medical Center, Dallas, USA.
Departments of Clinical Sciences (Biostatistics) and Psychiatry, University of Texas Southwestern Medical Center, Dallas, USA.
J Gastrointest Surg. 2018 Apr;22(4):695-702. doi: 10.1007/s11605-017-3624-6. Epub 2017 Nov 10.
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.
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).
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.
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.
关于辅助治疗在壶腹癌中的疗效的数据有限。本研究旨在确定辅助治疗是否与壶腹癌患者的生存改善相关。
我们从国家癌症数据库中确定了 2004 年至 2013 年间接受切除术的壶腹癌患者。我们进行了 1:1 倾向评分匹配，将术后接受观察的患者与接受辅助化疗（ACT）或辅助放化疗（ACRT）的患者进行比较。
我们确定了符合纳入标准的 4190 名患者；63%的患者接受了术后观察，21%接受了 ACT，16%接受了 ACRT。在匹配队列中，ACT 的使用与总生存的改善相关（HR=0.82，95%CI=0.71 至 0.95）。ACT 组的中位总生存时间为 47.2 个月，观察组为 35.5 个月。在另一项单独的匹配分析中，与观察相比，ACRT 也与生存改善相关（HR=0.84，95%CI=0.72 至 0.98）。ACRT 组的中位总生存时间为 38.1 个月，观察组为 31.0 个月。高危患者（如 T 和 N 类别较高的患者）的获益更为明显。
在这项回顾性研究中，壶腹癌中辅助治疗的使用与总生存的显著改善相关。辅助治疗对这种疾病的益处应通过随机对照试验以更严格的方式加以证实。
