Long-term oncologic benefit of postoperative chemotherapy in the resected ampulla of Vater cancer: hope or hype? A propensity score matching analysis.

Abstract

Purpose: The oncologic benefits of adjuvant chemotherapy for resected ampulla of Vater cancer (AoVCa) remain contentious. This study aimed to evaluate the long-term oncologic effects of postoperative adjuvant chemotherapy (PACT) in patients who underwent radical surgery for AoVCa.

Methods: From 2005 to 2019, clinical and pathological data of 306 AoVCa patients who underwent pancreatoduodenectomy were retrospectively reviewed. Patients were divided into the PACT (+) and PACT (-) groups. Propensity score matching (PSM) was conducted to adjust for clinical factors.

Results: The PACT (+) group (n = 124) and PACT (-) group (n = 182) showed significant differences in cancer stage, lymph node metastasis, perineural invasion, lymphovascular invasion, and cancer differentiation. Lower overall survival (OS) (P < 0.001) and disease-free survival (DFS) (P < 0.001) were observed in the PACT (+) group. After PSM, no significant differences in OS or DFS were found between the groups. Multivariate analysis identified lymph node metastasis and perineural invasion as significant prognostic factors, while PACT did not significantly impact long-term survival. Paradoxically, PACT was associated with worse outcomes in patients with favorable prognostic factors.

Conclusion: This study suggests that PACT does not provide a clear oncologic benefit for resected AoVCa patients and may even be detrimental for those with favorable prognostic factors. There is an urgent need to develop effective anticancer treatments and consider tailored therapeutic approaches based on individual patient profiles. Future research should focus on long-term follow-up and the integration of precision medicine to improve outcomes for AoVCa patients.