Survival benefit of adjuvant treatment for ampullary cancer with lymph nodal involvement: A systematic review and meta-analysis
Min Kyu Kim a , # , Jin Ho Choi b , # , In Rae Cho b , Sang Hyub Lee b , Ji Kon Ryu b ,Yong-Tae Kim b , Woo Hyun Paik b , ∗
a Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
b Department of Internal Medicine, Liver Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
Abstract：Background: The efficacy of adjuvant treatment (AT) in ampullary cancer (AmC) remains controversial. This systematic review and meta-analysis aimed to evaluate the role of AT for AmC.
Data sources: A comprehensive systematic search was performed in PubMed, EMBASE, Cochrane Library, and Web of Science databases. Studies comparing overall survival (OS) and recurrence-free survival (RFS) of patients who underwent AT or not following AmC resection were included.
Results: A total of 3971 patients in 21 studies were analyzed. Overall pooled data showed no significant difference in effect on the OS by AT [hazard ratio (HR) = 0.998, 95% confidence interval (CI): 0.768–1.297]. No significant difference in recurrence between the AT and non-AT (nAT) groups was noted (HR = 1.158, 95% CI: 0.764–1.755). In subgroup analysis, patients who received AT showed favorable outcomes in the OS compared with those who received nAT in nodal-positive AmC (HR = 0.627, 95% CI: 0.451–0.870). Neither AT consisted of adjuvant chemotherapy with radiotherapy (HR = 0.804, 95% CI: 0.563–1.149) nor AT with adjuvant chemotherapy (HR = 0.883, 95% CI: 0.642–1.214) showed any significant effect on the OS.
Conclusions: The effect of AT in AmC on survival and recurrence did not show a significant benefit. Furthermore, effectiveness according to AT strategies did not show enhancement in survival. AT had an advantage in survival compared with nAT strategy in nodal-positive AmC. In cases of AmC with positive lymph nodal involvement, AT may be warranted regardless of detailed strategies.
. [J]. Hepatobiliary Pancreat Dis Int, 2024, 23(6): 559-565.
Kim MK, Choi JH, Cho IR, Lee SH, Ryu JK, Kim YT, Paik WH. Survival benefit of adjuvant treatment for ampullary cancer with lymph nodal involvement: A systematic review and meta-analysis. Hepatobiliary Pancreat Dis Int, 2024, 23(6): 559-565.
2024, Vol. 23 
