E275: Multiagent Adjuvant Chemotherapy Associated with Improved Overall Survival in Resected Ampullary Adenocarcinoma

Although ampullary and duodenal carcinomas are generally perceived to be less lethal than pancreatic cancer, the recurrence and mortality rates of resected ampullary adenocarcinoma remains high. Current guidelines recommend adjuvant single agent chemotherapy for ampullary carcinoma and doublet therapy for node positive or high risk node negative duodenal cancer. This study investigates the survival benefit of adjuvant chemotherapy, specifically multiagent chemotherapy, in patient with resected ampullary adenocarcinoma.

Methods:

Using National Cancer Database, all patients with nonmetastatic ampullary adenocarcinoma who underwent definitive surgical resection from 2004-2020 were identified. Patients were stratified by receipt of adjuvant chemotherapy (no chemotherapy, single agent, multiagent). Univariate, multivariable logistic regression, and multivariable survival analysis was performed to determine benefit of adjuvant chemotherapy.

Results:

Of the 15,559 patients with ampullary adenocarcinoma, 45.7 % (7,103) received adjuvant chemotherapy. Single agent chemotherapy regimens were utilized slightly more (52.7%) compared to multiagent regimens (47.3%). Those receiving adjuvant chemotherapy were younger (63.7 vs 68.6 years, p< .001) and had fewer medical comorbidities (odds ratio (OR) 0.82, p< .001). Patients with a higher pathologic stage were more likely to receive adjuvant chemotherapy compared to those with Stage I disease (Stage II OR 5.99, p< .001 and Stage III OR 7.68, p< .001). Multivariable survival analysis adjusting for age, medical comorbidities, insurance status, and stage, demonstrated a significant improvement in overall survival associated with multiagent chemotherapy compared to no adjuvant chemotherapy (Hazard Ratio 0.71, p< .001).

Conclusions:

This study demonstrates a significant associated survival benefit of adjuvant chemotherapy in patients undergoing resection for ampullary adenocarcinoma, supporting current clinical guidelines. This study also suggests that multiagent regimens confers a greater benefit than single agent regimens in patients with resected ampullary adenocarcinoma, and could be considered in fit patients.