Adjuvant therapy may improve overall survival in high-risk periampullary adenocarcinomas patients – A match-pair analysis from a multi-institutional cohort study (The MIPPAP study)

IF 2.7 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Hpb Pub Date : 2024-10-01 DOI:10.1016/j.hpb.2024.06.010

Anant Ramaswamy , Vikram Chaudhari , Sujay Srinivas , Prabhat Bhargava , Sadhana Kannan , Ajit Agarwal , Ramakrishnan A. Seshadri , Vineet Talwar , Shaifali Goel , Varun Goel , Shivendra Singh , Smita Kayal , Pradeep Rebala , G.V. Rao , Bharat Prajapati , Devendra Parikh , Jagdish Kothari , Jacob M. Kadamapuzha , Hariharan Ramesh , Deeksha Kapoor , Vikas Ostwal

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引用次数: 0

Abstract

Background

The role of adjuvant therapy in resected periampullary adenocarcinomas is equivocal due to contrasting data and limited prospective trials.

Methods

The Multicentre Indian Pancreatic & Periampullary Adenocarcinoma Project (MIPPAP), included data from 8 institutions across India. Of the 1679 pancreatic resections, 736 patients with T3/T4 and/or Node positive adenocarcinomas (considered as high risk for recurrence) were included for analysis. Three (adjuvant): one (observation) matching, using T3/T4 T staging, nodal positivity and ampullary subtype was performed by using the nearest neighbour matching method.

Results

Of 736 patients eligible for inclusion, 621 patients were matched of which 458 patients received adjuvant therapy (AT) (predominantly gemcitabine-based) and 163 patients were observed (O). With a median follow-up of 42 months, there was a statistical difference in overall survival in favour of patients receiving AT as compared to those on observation [68.7 months vs. 61.1 months, Hazard ratio: 0.73 (95% CI: 0.54–0.97); p = 0.03]. Besides AT, presence of nodal involvement (median OS: 65.4 months vs not reached; p = 0.04) predicted for inferior OS.

Conclusions

The results of the match-pair analysis suggest that adjuvant therapy improves overall survival in periampullary adenocarcinomas at high risk of recurrence with a greater benefit in T3/T4, node-positive and ampullary subtypes.

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辅助治疗可提高高危胰周腺癌患者的总生存率 - 一项多机构队列研究（MIPPAP 研究）的配对分析

由于数据对比不一且前瞻性试验有限，辅助治疗在切除的胰腺周围腺癌中的作用并不明确。印度胰腺和胰周腺癌多中心项目（MISSPAP）的数据来自印度8家主要学术机构。在 1679 例胰腺切除术中，有 736 例 T3/T4 和/或结节阳性腺癌患者（被认为复发风险高）符合纳入标准，可供分析。采用最近邻匹配法，使用 T3/T4 T 分期、结节阳性和髓质亚型进行三（辅助）：一（观察）匹配，无替换。在符合纳入条件的 736 名患者中，有 621 名患者进行了配对，其中 458 名患者接受了辅助治疗（AT）（主要以吉西他滨为主），163 名患者接受了观察治疗（O）。中位随访时间为42个月，接受辅助治疗和接受观察的患者的3年、估计5年OS和中位OS分别为67.1%（95% CI：62.4-72.2）和62%（95% CI：54.2-70.7）、57.5%（52-63.8）和51.1%（95% CI：42.5%-61.4%）以及68.7（95% CI：59.6-73.1）个月和61.1个月（95% CI：50.8-71.5）。与接受观察的患者相比，接受 AT 治疗的患者的 OS 存在统计学差异[危险比：0.73（95% CI：0.54-0.97）；P = 0.03]。除了 AT 外，结节受累（中位 OS：65.4 个月 vs 未达到；p = 0.04）也预示着较差的 OS。在大多数亚组中，AT有改善OS的趋势，对T3/T4 T分期、结节阳性和髓瓿亚型患者的影响更大。配对分析结果表明，辅助治疗可提高复发风险高的胰周腺癌患者的总生存率，对T3/T4、结节阳性和胰腺亚型患者的益处更大。

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来源期刊

Hpb GASTROENTEROLOGY & HEPATOLOGY-SURGERY

CiteScore

5.60

自引率

3.40%

发文量

244

审稿时长

57 days

期刊介绍： HPB is an international forum for clinical, scientific and educational communication. Twelve issues a year bring the reader leading articles, expert reviews, original articles, images, editorials, and reader correspondence encompassing all aspects of benign and malignant hepatobiliary disease and its management. HPB features relevant aspects of clinical and translational research and practice. Specific areas of interest include HPB diseases encountered globally by clinical practitioners in this specialist field of gastrointestinal surgery. The journal addresses the challenges faced in the management of cancer involving the liver, biliary system and pancreas. While surgical oncology represents a large part of HPB practice, submission of manuscripts relating to liver and pancreas transplantation, the treatment of benign conditions such as acute and chronic pancreatitis, and those relating to hepatobiliary infection and inflammation are also welcomed. There will be a focus on developing a multidisciplinary approach to diagnosis and treatment with endoscopic and laparoscopic approaches, radiological interventions and surgical techniques being strongly represented. HPB welcomes submission of manuscripts in all these areas and in scientific focused research that has clear clinical relevance to HPB surgical practice. HPB aims to help its readers - surgeons, physicians, radiologists and basic scientists - to develop their knowledge and practice. HPB will be of interest to specialists involved in the management of hepatobiliary and pancreatic disease however will also inform those working in related fields. Abstracted and Indexed in: MEDLINE® EMBASE PubMed Science Citation Index Expanded Academic Search (EBSCO) HPB is owned by the International Hepato-Pancreato-Biliary Association (IHPBA) and is also the official Journal of the American Hepato-Pancreato-Biliary Association (AHPBA), the Asian-Pacific Hepato Pancreatic Biliary Association (A-PHPBA) and the European-African Hepato-Pancreatic Biliary Association (E-AHPBA).