JAMA surgery · 2019
Role of Adjuvant Multimodality Therapy After Curative-Intent Resection of Ampullary Carcinoma.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод пока не подготовлен
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Ecker Brett L, Vollmer Charles M, Behrman Stephen W, Allegrini Valentina, Aversa John, Ball Chad G, Barrows Courtney E, Berger Adam C, Cagigas Martha N, Christein John D, Dixon Elijah, Fisher William E, Freedman-Weiss Mollie, Guzman-Pruneda Francisco, Hollis Robert H, House Michael G, Kent Tara S, Kowalsky Stacy J, Malleo Giuseppe, Salem Ronald R, Salvia Roberto, Schmidt Carl R, Seykora Thomas F, Zheng Richard, Zureikat Amer H, Dickson Paxton V
Аннотация
IMPORTANCE: Ampullary adenocarcinoma is a rare malignant neoplasm that arises within the duodenal ampullary complex. The role of adjuvant therapy (AT) in the treatment of ampullary adenocarcinoma has not been clearly defined.
OBJECTIVE: To determine if long-term survival after curative-intent resection of ampullary adenocarcinoma may be improved by selection of patients for AT directed by histologic subtype.
DESIGN, SETTING, AND PARTICIPANTS: This multinational, retrospective cohort study was conducted at 12 institutions from April 1, 2000, to July 31, 2017, among 357 patients with resected, nonmetastatic ampullary adenocarcinoma receiving surgery alone or AT. Cox proportional hazards regression was used to identify covariates associated with overall survival. The surgery alone and AT cohorts were matched 1:1 by propensity scores based on the likelihood of receiving AT or by survival hazard from Cox modeling. Overall survival was compared with Kaplan-Meier estimates.
EXPOSURES: Adjuvant chemotherapy (fluorouracil- or gemcitabine-based) with or without radiotherapy.
MAIN OUTCOMES AND MEASURES: Overall survival.
RESULTS: A total of 357 patients (156 women and 201 men; median age, 65.8 years [interquartile range, 58-74 years]) underwent curative-intent resection of ampullary adenocarcinoma. Patients with intestinal subtype had a longer median overall survival compared with those with pancreatobiliary subtype (77 vs 54 months; P = .05). Histologic subtype was not associated with AT administration (intestinal, 52.9% [101 of 191]; and pancreatobiliary, 59.5% [78 of 131]; P = .24). Patients with pancreatobiliary histologic subtype most commonly received gemcitabine-based regimens (71.0% [22 of 31]) or combinations of gemcitabine and fluorouracil (12.9% [4 of 31]), whereas treatment of those with intestinal histologic subtype was more varied (fluorouracil, 50.0% [17 of 34]; gemcitabine, 44.1% [15 of 34]; P = .01). In the propensity score-matched cohort, AT was not associated with a survival benefit for either histologic subtype (intestinal: hazard ratio, 1.21; 95% CI, 0.67-2.16; P = .53; pancreatobiliary: hazard ratio, 1.35; 95% CI, 0.66-2.76; P = .41).
CONCLUSIONS AND RELEVANCE: Adjuvant therapy was more frequently used in patients with poor prognostic factors but was not associated with demonstrable improvements in survival, regardless of tumor histologic subtype. The value of a multimodality regimen remains poorly defined.
OBJECTIVE: To determine if long-term survival after curative-intent resection of ampullary adenocarcinoma may be improved by selection of patients for AT directed by histologic subtype.
DESIGN, SETTING, AND PARTICIPANTS: This multinational, retrospective cohort study was conducted at 12 institutions from April 1, 2000, to July 31, 2017, among 357 patients with resected, nonmetastatic ampullary adenocarcinoma receiving surgery alone or AT. Cox proportional hazards regression was used to identify covariates associated with overall survival. The surgery alone and AT cohorts were matched 1:1 by propensity scores based on the likelihood of receiving AT or by survival hazard from Cox modeling. Overall survival was compared with Kaplan-Meier estimates.
EXPOSURES: Adjuvant chemotherapy (fluorouracil- or gemcitabine-based) with or without radiotherapy.
MAIN OUTCOMES AND MEASURES: Overall survival.
RESULTS: A total of 357 patients (156 women and 201 men; median age, 65.8 years [interquartile range, 58-74 years]) underwent curative-intent resection of ampullary adenocarcinoma. Patients with intestinal subtype had a longer median overall survival compared with those with pancreatobiliary subtype (77 vs 54 months; P = .05). Histologic subtype was not associated with AT administration (intestinal, 52.9% [101 of 191]; and pancreatobiliary, 59.5% [78 of 131]; P = .24). Patients with pancreatobiliary histologic subtype most commonly received gemcitabine-based regimens (71.0% [22 of 31]) or combinations of gemcitabine and fluorouracil (12.9% [4 of 31]), whereas treatment of those with intestinal histologic subtype was more varied (fluorouracil, 50.0% [17 of 34]; gemcitabine, 44.1% [15 of 34]; P = .01). In the propensity score-matched cohort, AT was not associated with a survival benefit for either histologic subtype (intestinal: hazard ratio, 1.21; 95% CI, 0.67-2.16; P = .53; pancreatobiliary: hazard ratio, 1.35; 95% CI, 0.66-2.76; P = .41).
CONCLUSIONS AND RELEVANCE: Adjuvant therapy was more frequently used in patients with poor prognostic factors but was not associated with demonstrable improvements in survival, regardless of tumor histologic subtype. The value of a multimodality regimen remains poorly defined.
Предметные рубрики MeSH
AdenocarcinomaAgedAmpulla of VaterAntimetabolites, AntineoplasticChemoradiotherapy, AdjuvantCombined Modality TherapyCommon Bile Duct NeoplasmsDeoxycytidineFemaleFluorouracilFollow-Up StudiesHumansImmunosuppressive AgentsMaleMiddle AgedNeoplasm StagingPancreaticoduodenectomyPrognosisPropensity ScoreRetrospective StudiesSurvival RateUnited StatesGemcitabine