C. H. Hester1, E. A. Dogeas1, M. A. Augustine1, J. A. Mansour1, P. A. Polanco1,2, M. A. Porembka1, S. A. Wang1, H. A. Zeh1, A. A. Yopp1 1University Of Texas Southwestern Medical Center,Surgical Oncology,Dallas, TX, USA 2Department of Veterans Affairs North Texas Health Care System,Surgical Oncology,Dallas, TX, USA
Introduction: 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 NCDB from 2004-2012. Clinicopathological variables were compared between subtypes. Covariate-adjusted treatment use and OS were compared.
Results: 116,705 patients with PAC were identified: 10,320 (9%) AA, 3,732 (3%) DCC, 7,142 (6%) DA and 95,511 (82%) PDAC. DA, DCC, and PDAC were associated with worse survival compared to AA (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 to 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.