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Incidence and comparative outcomes of periampullary cancer: A population‐based analysis demonstrating improved outcomes and increased use of adjuvant therapy from 2004 to 2012
Author(s) -
Hester Caitlin A.,
Dogeas Epameidas,
Augustine Mathew M.,
Mansour John C.,
Polanco Patricio M.,
Porembka Matthew R.,
Wang Sam C.,
Zeh Herbert J.,
Yopp Adam C.
Publication year - 2019
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.25336
Subject(s) - medicine , hazard ratio , gastroenterology , adenocarcinoma , neoadjuvant therapy , incidence (geometry) , oncology , adjuvant therapy , pancreatic cancer , population , cancer , confidence interval , breast cancer , physics , environmental health , optics
Background and Objectives Periampullary adenocarcinoma (PAC) is stratified anatomically: ampullary adenocarcinoma (AA), distal cholangiocarcinoma (DCC), duodenal adenocarcinoma (DA), and pancreatic ductal adenocarcinoma (PDAC). We aimed to determine differences in incidence, prognosis, and treatment in stage‐matched PAC patients in a longitudinal study. Methods PAC patients were identified in The National Cancer Database from 2004 to 2012. Clinicopathological variables were compared between subtypes. Covariate‐adjusted treatment use and OS were compared. Results The 116 705 patients with PAC were identified: 1320 (9%) AA, 3732 (3%) DCC, 7142 (6%) DA, and 95 511 (82%) PDAC. DA, DCC, and PDAC were associated with worse survival compared with AA (hazard ratio [HR], 1.10; 95% CI, 1.1‐1.1; HR, 1.50; 95% CI, 1.4‐1.6, and HR, 1.90; 95% CI, 1.8‐1.9). Among resected patients, DA was associated with improved survival compared with AA (HR, 0.70; 95% CI, 0.67‐0.75); DCC and PDAC were associated with worse survival (HR, 1.41; 95% CI, 1.31‐1.53 and HR, 2.041; 95% CI, 1.07‐2.12). Resected AA, PDAC, and DA, but not DCC, demonstrated significantly improved survival over the studied period. While all patients had increased adjuvant therapy (AT) receipt over time ( P < 0.001), only patients with PDAC had increased neoadjuvant therapy (NAT) receipt ( P < 0.001). Conclusion Resected PDAC, AA, and DA were associated with clinically significant improved survival over time, mirroring a concurrent associated increased receipt of AT.