Srivastava Anurita, Nekarakanti Phani Kumar, Kanchodu Sudheer, Srivastava Siddharth, Mishra Pramod Kumar, Saluja Sundeep Singh
Department of Radiotherapy, Maulana Azad Medical College (MAMC), New Delhi, India.
Department of GI Surgery, Govind Ballabh Pant Institute of Postgraduate Medical Education & Research (GIPMER), New Delhi, India.
Ann Hepatobiliary Pancreat Surg. 2024 Aug 31;28(3):371-380. doi: 10.14701/ahbps.24-032. Epub 2024 Apr 11.
BACKGROUNDS/AIMS: The published data had contradictory information on the role of adjuvant therapy on resected periampullary carcinomas (PACA). The study was performed to evaluate the survival benefit of adjuvant treatment.
This was a propensity score matched case-control study from a prospectively maintained database from 2004-2019. The study included patients with nonpancreatic PACA who underwent curative resection. The patients (cases) who received adjuvant chemotherapy were compared with patients (controls) who were observed alone after surgery.
Of 510 patients with PACA, 230 patients (cases = 107, controls = 123) formed the unmatched study cohort. After propensity score matching, 140 patients (cases = 70, controls = 70) formed the matched study cohort. The median overall survival (OS) was similar in cases than controls in the unmatched population but doubled non-significantly in cases after matching (unmatched population, 54 months vs. 54 months, -value = 0.624; matched population, 71 months vs. 36 months, -value = 0.087). However, the median recurrence-free survival (RFS) was non significantly higher in the control group (unmatched population, 59 months vs. 38 months, -value = 0.195; matched population, 53 months vs. 40 months, -value = 0.797). In cox regression analysis, age < 60 years, advanced T stage, and presence of perineural invasion were independent factors for worse RFS, while tumor recurrence was an independent factor for poor OS.
Patients with nonpancreatic PACA may have an OS benefit from adjuvant chemotherapy, and this needs to be validated with large prospective randomized studies.
背景/目的：已发表的数据关于辅助治疗对壶腹周围癌（PACA）切除术后的作用存在相互矛盾的信息。本研究旨在评估辅助治疗的生存获益。
这是一项倾向评分匹配的病例对照研究，数据来自2004年至2019年前瞻性维护的数据库。研究纳入接受根治性切除的非胰腺PACA患者。将接受辅助化疗的患者（病例组）与术后仅接受观察的患者（对照组）进行比较。
在510例PACA患者中，230例患者（病例组 = 107例，对照组 = 123例）构成未匹配的研究队列。倾向评分匹配后，140例患者（病例组 = 70例，对照组 = 70例）构成匹配的研究队列。在未匹配人群中，病例组和对照组的中位总生存期（OS）相似，但匹配后病例组的中位总生存期非显著性翻倍（未匹配人群，54个月对54个月，P值 = 0.624；匹配人群，71个月对36个月，P值 = 0.087）。然而，对照组的无复发生存期（RFS）中位数非显著性更高（未匹配人群，59个月对38个月，P值 = 0.195；匹配人群，53个月对40个月，P值 = 0.797）。在Cox回归分析中，年龄 < 60岁、T分期晚期和存在神经周围侵犯是RFS较差的独立因素，而肿瘤复发是OS较差的独立因素。
非胰腺PACA患者可能从辅助化疗中获得OS获益，这需要通过大型前瞻性随机研究进行验证。
