Neoadjuvant chemotherapy versus upfront resection in ampullary adenocarcinoma stratified by stage: A retrospective analysis using the National Cancer Database.

Abstract

318Background: Outcomes of a neoadjuvant therapy (NAT) strategy to treat ampullary adenocarcinoma (AAC) are unclear. Upfront resection (UR) (typically pancreaticoduodenectomy) with or without adjuvant therapy (AT) is currently the standard of care. We looked to assess outcomes of NAT followed by radical surgery for AAC. Methods: The NCDB was queried for ampullary carcinoma patients from 2004-2015. Patients with Stage I to III AAC who underwent radical surgery were included, and separated into NAT with surgery and UR groups. Demographic/clinical/pathologic data and their associations to survival were analyzed with univariate and multivariate cox proportional hazard models. Overall survival was estimated from time of diagnosis using Kaplan-Meier curves and compared using log-rank tests (LRT) (see table). Statistical analyses were performed using R version 3.5.1 with significance established at p < 0.05. Results: There was no difference in overall survival between the NAT (n = 47) and UR (n = 1521) groups, e...