Treatment and overall survival of four types of non-metastatic periampullary cancer: nationwide population-based cohort study

Abstract

Background: Periampullary adenocarcinoma consists of pancreatic adenocarcinoma (PDAC), distal cholangiocarcinoma (DC), ampullary cancer (AC), and duodenal adenocarcinoma (DA). The aim of this study was to assess treatment modalities and overall survival by tumor origin.Methods: Patients diagnosed with non-metastatic periampullary cancer in 2012-2018 were identified from the Netherlands Cancer Registry. OS was studied with Kaplan-Meier analysis and multivariable Cox regression analyses, stratified by origin.Results: Among the 8758 patients included, 68% had PDAC, 13% DC, 12% AC, and 7% DA. Resection was performed in 35% of PDAC, 56% of DC, 70% of AC, and 59% of DA. Neoadjuvant and/or adjuvant therapy was administered in 22% of PDAC, 7% of DC, 7% of AC, and 12% of DA. Three-year OS was highest for AC (37%) and DA (34%), followed by DC (21%) and PDAC (11%). Adjuvant therapy was associated with improved OS among PDAC (HR = 0.62; 95% CI 0.55-0.69) and DC (HR = 0.69; 95% CI 0.48-0.98), but not AC (HR = 0.87; 95% CI 0.62-1.22) and DA (HR = 0.85; 95% CI 0.48-1.50). Conclusion:This retrospective study identified considerable differences in treatment modalities and OS between the four periampullary cancer origins in daily clinical practice. An improved OS after adjuvant chemotherapy could not be demonstrated in patients with AC and DA. Q4

Evaluation of Systemic Treatments of Small Intestinal Adenocarcinomas

“…After full-text revision, 57 studies were included, with a total of 35 176 patients. Among the 57 studies, 6 studies 27 , 28 , 29 , 30 , 31 , 32 were prospective cohort studies or phase 2 trials, and 51 studies 1 , 3 , 4 , 17 , 19 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 were retrospective in nature ( Table ; eTables 1 and 2 in…”

Machine learning models for predicting survival in patients with ampullary adenocarcinoma

“… 1 , 2 The incidence of AAC is estimated to be 0.5, 0.73, and 0.96 per 100,000 persons per year in the US, Japan, and the Netherlands, respectively. 3 , 4 , 5 Despite its rarity, the occurrence of AAC has increased worldwide over the past few decades. 6 , 7 Patients with AAC tend to present typical symptoms of biliary obstruction at relatively early stages, but these symptoms are mostly non-specific and are therefore often detected incidentally during examinations.…”

“…Previous research has used various types of prediction models to assess the short-term survival rates of AAC, including Kaplan–Meier survival analysis, logistic regression, and the Cox proportional hazards (CoxPH) model. 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 Kaplan–Meier survival analysis is the most commonly method used to investigate the prognostic factors for AAC, which does not allow adjustments for confounders and has a restrictive assumption of non-informative censoring. 24 , 25 Logistic regression models aim to estimate the relationship between potential factors and survival outcomes as well as adjust for confounders.…”

“…that originates in biliary, duodenal, or pancreatic ductal epithelial cells 1,2 . The incidence of AAC is estimated to be 0.5, 0.73, and 0.96 per 100,000 persons per year in the US, Japan, and the Netherlands, respectively [3][4][5] . Despite its rarity, the occurrence of AAC has increased worldwide over the past few decades 6,7 .…”

“…Previous research has used various types of prediction models to assess the shortterm survival rates of AAC, including Kaplan-Meier survival analysis, logistic regression, and the Cox proportional-hazards (CoxPH) model [5][6][7][8][9][10][11][12][13][16][17][18][19][20][21][22][23] . Kaplan-Meier J o u r n a l P r e -p r o o f survival analysis is the most commonly method used to investigate the prognostic factors for AAC, which does not allow adjustments for confounders and has a restrictive assumption of noninformative censoring 24,25 .…”