Impact of adjuvant therapy on long-term survival in patients with duodenal adenocarcinoma: Insights from a population-based propensity-matched study.

Abstract

Background: The efficacy of adjuvant treatment in resected duodenal adenocarcinoma has not been well established. This study aimed to evaluate the impact of postoperative chemotherapy (POCT) and postoperative chemoradiotherapy (POCRT) on survival in this rare malignancy.

Methods: Patients diagnosed with duodenal adenocarcinoma from SEER database between 2004 and 2019 were identified. Overall survival (OS) and cancer-specific survival (CSS) were analyzed before and after propensity score matching (PSM). Subgroup analyses were conducted to identify which patient groups benefited from adjuvant therapy.

Results: Among the 1320 eligible patients, 33.8 % received surgery plus POCT, and 10.8 % received surgery plus POCRT. Compared to surgery alone, POCT significantly improved OS both before and after PSM (P < 0.001). While no significant CSS benefit was observed in the unmatched population, PSM analysis showed improved CSS with POCT (P < 0.001). In contrast, POCRT did not improve OS or CSS, regardless of PSM. Subgroup analyses revealed no survival benefit from POCT in patients younger than 68, those with N0 stage, stage I-II disease, or Black race. POCRT did not significantly improve outcomes in any subgroup.

Conclusions: POCT demonstrates a survival benefit in locally advanced duodenal adenocarcinoma, whereas POCRT does not improve outcomes. Patients younger than 68, with N0 stage, stage I-II disease, or of Black race may not benefit from POCT.

Impact: These findings guide clinical decision-making by identifying patient subgroups that benefit from adjuvant chemotherapy while suggesting limited utility for chemoradiotherapy in this setting.