Park SJ, Shin K, Kim IH, Hong TH, Kim Y, Lee MA. Role of adjuvant chemotherapy on recurrence and survival in patients with resected ampulla of Vater carcinoma. World J Gastrointest Oncol 2023; 15(4): 677-688 [PMID: 37123060 DOI: 10.4251/wjgo.v15.i4.677]
Corresponding Author of This Article
Myung-ah Lee, MD, PhD, Professor, Division of Medical Oncology, Department of Internal Medicine, The Catholic University of Korea, Seoul St. Mary’s Hospital, 222 Banpo-daero, Secho-gu, Seoul 06591, South Korea. angelamd@catholic.ac.kr
Research Domain of This Article
Oncology
Article-Type of This Article
Retrospective Cohort Study
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Park SJ, Shin K, Kim IH, Hong TH, Kim Y, Lee MA. Role of adjuvant chemotherapy on recurrence and survival in patients with resected ampulla of Vater carcinoma. World J Gastrointest Oncol 2023; 15(4): 677-688 [PMID: 37123060 DOI: 10.4251/wjgo.v15.i4.677]
World J Gastrointest Oncol. Apr 15, 2023; 15(4): 677-688 Published online Apr 15, 2023. doi: 10.4251/wjgo.v15.i4.677
Role of adjuvant chemotherapy on recurrence and survival in patients with resected ampulla of Vater carcinoma
Se Jun Park, Kabsoo Shin, In-Ho Kim, Tae Ho Hong, Younghoon Kim, Myung-ah Lee
Se Jun Park, Kabsoo Shin, In-Ho Kim, Myung-ah Lee, Division of Medical Oncology, Department of Internal Medicine, The Catholic University of Korea, Seoul St. Mary’s Hospital, Seoul 06591, South Korea
Tae Ho Hong, Department of General Surgery, The Catholic University of Korea, Seoul St. Mary’s Hospital, Seoul 06591, South Korea
Younghoon Kim, Department of Pathology, The Catholic University of Korea, Seoul St. Mary’s Hospital, Seoul 06591, South Korea
Author contributions: All authors helped to perform the research; Park SJ was involved in manuscript writing, drafting conception and design, acquisition of data, performing procedures, and data analysis; Shin KS, Kim IH, Hong TH, and Kim Y contributed to writing the manuscript; Lee MA contributed to writing the manuscript, drafting conception and design, performing procedures, and data analysis; all authors have read and approved the final manuscript.
Institutional review board statement: The study conformed to Korean regulations and the Declaration of Helsinki. Ethical approval was provided by the Institutional Review Board (IRB) of The Catholic University of Korea, Seoul St. Mary’s Hospital (approval ID: KC21RISI0518).
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent. We received Institutional Review Board approval to conduct our study without consent process.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: The datasets used in this study are available from the corresponding author upon request.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Corresponding author: Myung-ah Lee, MD, PhD, Professor, Division of Medical Oncology, Department of Internal Medicine, The Catholic University of Korea, Seoul St. Mary’s Hospital, 222 Banpo-daero, Secho-gu, Seoul 06591, South Korea. angelamd@catholic.ac.kr
Received: December 24, 2022 Peer-review started: December 24, 2022 First decision: February 10, 2023 Revised: February 20, 2023 Accepted: March 22, 2023 Article in press: March 22, 2023 Published online: April 15, 2023 Processing time: 108 Days and 23.1 Hours
ARTICLE HIGHLIGHTS
Research background
Surgical resection is the primary curative approach for patients with localized Ampulla of Vater (AoV) carcinoma, but recurrence is frequent. There is no standard adjuvant treatment globally accepted for resected AoV carcinoma.
Research motivation
A significant number of surgically resected AoV carcinoma patients experience recurrence, and there is a great unmet need because standard adjuvant treatment has not been established.
Research objectives
The purpose of this study was to determine the correlation between fluorouracil-based adjuvant chemotherapy and prognosis in surgically resected AoV carcinoma patients.
Research methods
The association between adjuvant chemotherapy and survival outcomes in patients with stage IB-III AoV carcinoma who underwent surgical resection was analyzed. The administration of fluorouracil-based adjuvant chemotherapy after surgery was determined by the physician's discretion. Adjusted multivariate regression models were utilized to evaluate the correlation between adjuvant chemotherapy and disease-free survival and overall survival.
Research results
After curative surgery for AoV carcinoma, 52 patients received adjuvant chemotherapy. Multivariate analysis showed that advanced tumor stage, higher histologic grade, and vascular invasion were linked with shorter disease-free survival (DFS). Adjuvant chemotherapy improved DFS and was linked with a longer overall survival, although this was not statistically significant.
Research conclusions
Overall, our study found no significant survival benefit of fluorouracil-based adjuvant chemotherapy in patients with resected AoV carcinoma. However, multivariate analysis revealed a positive association between adjuvant chemotherapy and improved DFS. Further research is needed to identify subgroups of resected AoV cancer patients who may benefit from adjuvant chemotherapy.
Research perspectives
This study evaluated a relatively homogenous population with a consistent chemotherapy regimen, which is considered a strength in contrast to most retrospective studies that included heterogeneous populations and used inconsistent adjuvant treatment regimens. Patients with tumors that invade beyond the sphincter of Oddi could be considered for adjuvant treatment following surgery as a considerable proportion of stage IB patients experience relapses. These findings will aid in identifying appropriate candidates for adjuvant treatment in patients with AoV carcinoma.
