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Multicenter Study
. 2024 Jul;131(1):117-125.
doi: 10.1038/s41416-024-02692-w. Epub 2024 May 28.

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

Bas A Uijterwijk  1   2   3 , Daniël H Lemmers  4   5   6 , Michele Ghidini  7 , Johanna W Wilmink  6   8 , Alberto Zaniboni  9 , Giuseppe Kito Fusai  10 , Alessandro Zerbi  11   12 , Bas Groot Koerkamp  13 , Misha Luyer  14 , Poya Ghorbani  15 , Roberto Salvia  16 , Steven White  17 , Benedetto Ielpo  18 , Brian K P Goh  19 , Ugo Boggi  20 , Geert Kazemier  6   21 , Michael G House  22 , Vasileios K Mavroeidis  23   24 , Bergthor Björnsson  25 , Michele Mazzola  26 , Mario Serradilla  27 , Dimitris Korkolis  28 , Adnan Alseidi  29 , Keith J Roberts  30 , Zahir Soonawalla  24 , Patrick Pessaux  31 , William E Fisher  32 , Sharnice Koek  33 , Tara S Kent  34 , Miljana Vladimirov  35 , Louisa Bolm  36 , Nigel Jamieson  37 , Raffaele Dalla Valle  38 , Jorg Kleeff  39 , Alessandro Mazzotta  40 , Miguel Angel Suarez Muñoz  41 , Santiago Sánchez Cabús  42 , Chad G Ball  43 , Adam C Berger  44 , Clarissa Ferarri  4 , Marc G Besselink  5   6 , Mohammed Abu Hilal  45 ; International Study Group on non-pancreatic periampullary Cancer (ISGACA)
Affiliations
Multicenter Study

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

Bas A Uijterwijk et al. Br J Cancer. 2024 Jul.

Abstract

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.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1. Methodology with summary of inclusions and comparisons.
ISGACA International Study Group on Non-pancreatic Periampullary Cancer, ACT adjuvant chemotherapy, 5FU/cap 5-fluorouracil or Capecitabine mono, Fluor+plat fluoropyrimidine + platinum combination, Gem Gemcitabine monotherapy, Cap. Capecitabine, Gem+Cis Gemcitabine + Cisplatin. The bold figure names include significant differences (P < 0.05).
Fig. 2
Fig. 2. Duodenal adenocarcinoma.
a (left): yes vs no adjuvant chemotherapy after propensity-score matching; b (right): 5FU/Cap. Mono vs. Fluoropyrimidine + Platinum vs. Gemcitabine mono. Duodenum AC Duodenum adenocarcinoma, Adjuvant CT Adjuvant chemotherapy, 5FU 5-fluorouracil, Cap Capecitabin, Flu Fluoropyrimidine, Plat Platinum, Gem Gemcitabine.
Fig. 3
Fig. 3. Ampullary adenocarcinoma intestinal subtype.
a (left): yes vs no adjuvant chemotherapy after propensity-score matching; b (right): 5FU/Cap. Mono vs. Fluoropyrimidine + Platinum vs. Gemcitabine mono. Adjuvant CT Adjuvant chemotherapy, 5FU 5-fluorouracil, Cap. Capecitabin, Flu Fluoropyrimidine, Plat, Platinum, Gem Gemcitabine.
Fig. 4
Fig. 4. Ampullary adenocarcinoma pancreatobiliary.
a (left): yes vs no adjuvant chemotherapy after propensity-score matching; b (right): 5FU/Cap. Mono vs. Fluoropyrimidine + Platinum vs. Gemcitabine mono. Amp. Pancreatobiliary, Ampullary adenocarcinoma pancreatobiliary subtype, Adjuvant CT Adjuvant chemotherapy, 5FU 5-fluorouracil, Cap. Capecitabin, Flu Fluoropyrimidine, Plat Platinum, Gem Gemcitabine.
Fig. 5
Fig. 5. Distal cholangiocarcinoma.
a (left): yes vs no adjuvant chemotherapy after propensity-score matching; b (right): capecitabine vs gemcitabine vs gemcitabine-cisplatin. Distal cholangioCA distal cholangiocarcinoma, Adjuvant CT Adjuvant chemotherapy, Cap capecitabine, Gem gemcitabine, Gem-Cis gemcitabine + cisplatin.
See this image and copyright information in PMC

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