E292: Single Versus Multiagent Chemotherapy for Ampullary Carcinoma: A Multivariate Analysis of the NCDB

Pancreatoduodenectomy remains the standard of care for ampullary carcinoma, however the role of adjuvant chemotherapy remains unclear.   We investigated what survival benefits may be found when comparing single vs. multi-agent chemotherapy regimens.

Methods:

The National Cancer Database (NCDB) was queried to identify patients ≥18 years old diagnosed with stage II or III carcinoma of the ampulla of Vater between years 2013-2020.   Kaplan-Meier (K-M) analysis compared overall survival time by single-agent vs. multi-agent chemotherapy when a surgical procedure was performed.  Cox regression analyses examined differences by number of agents while controlling for covariates including age, race, number of comorbidities, and year of diagnosis. Multi-agent usage increased dramatically in 2017, so we categorized by years 2013-2016 vs 2017-2020.

Results:

2660 patients were included: 1115 who received single agent vs. 1505 who received multi-agent chemotherapy.  K-M analyses showed survival was better with multi--agent chemotherapy for both stage II (p=0.03) and III disease (p=0.02).   In contrast, multivariate models found that for both stage II and III, number of agents was not associated with survival time when controlling for covariates.  For stage III disease, Black race (compared to White), older age (compared to < 65), and patients with earlier year of diagnosis (2013-2016) had worse overall survival.  For stage II disease, only older age was associated with shorter survival time.

Conclusions:

For nonmetastatic, locally advanced ampullary cancer, there is no significant difference in overall survival when comparing single vs. multi-agent chemotherapy when controlling for covariates.