Adjuvant chemotherapy for resected duodenal adenocarcinoma: a case-matched analysis in nation wide cohort

Abstract

Background

Duodenal adenocarcinoma (DA) is a rare tumor for which survival data on adjuvant chemotherapy in patients after surgical treatment are unclear. This case-matched study in a nationwide cohort aims to investigate the benefit of adjuvant chemotherapy for patients with resectable DA on overall survival.

Methods

All patients diagnosed with DA and intestinal type periampullary adenocarcinoma (PVA) in the Netherlands between 2000 and 2015 were included (n = 1316). Patients with disease stages II and III who underwent resection and adjuvant chemotherapy were matched (1:2), based on identified covariates associated with OS, with patients who underwent surgery alone. Overall survival was compared using Kaplan-Meier estimates.

Results

The median OS was 49.9 months in patients who underwent curative resection (n = 649). Univariate and multivariate analysis showed a significant influence of age, lymph node involvement, and T- stage on survival. The group of patients receiving adjuvant treatment consisted of 43 patients and the non-adjuvant group of 83 case-matched patients. The median OS of the complete matched cohort (n = 126) was 26.9 months. No statistically significant survival benefit was found for the adjuvant group as compared to the group treated with surgery alone (median OS = 34.4 months and 23.0 months, p = 0.20).

Conclusion

This population-based, case-matched analysis demonstrates no statistically significant survival benefit for adjuvant chemotherapy after curative resection in stages II and III patients. Future studies with specified treatment regimens as well as thorough stratification for prognostic factors will be required in order to more definitively determine the role of adjuvant therapy.

Keywords:

• Duodenal
• adenocarcinoma
• adjuvant
• chemotherapy
• survival

Authors contributions

JB, LM, NG BL and GK were involved in the conception and design of the study, acquisition of data, analysis and interpretation of data, drafting and revising critically for the important intellectual content of all versions of the article, and gave the final approval of this version of the manuscript to be published. JB, LM, BZ, HV, FD, NG, BL and GK were involved in the conception and design of the study, interpretation of data, revising critically for the important intellectual content of all versions of the article, and gave final approval of this version of the manuscript to be published.

Disclosure statement

The authors declare that they have no competing interests.

Data availability statement

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.