Adjuvant therapy may improve overall survival in high-risk periampullary adenocarcinomas patients - A match-pair analysis from a multi-institutional cohort study (The MIPPAP study).

HPB : the official journal of the International Hepato Pancreato Biliary Association 2024 Oct

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The role of adjuvant therapy in resected periampullary adenocarcinomas is equivocal due to contrasting data and limited prospective trials. The Multicentre Indian Pancreatic & Periampullary Adenocarcinoma Project (MIPPAP), included data from 8 institutions across India. Of the 1679 pancreatic resections, 736 patients with T3/T4 and/or Node positive adenocarcinomas (considered as high risk for recurrence) were included for analysis. Three (adjuvant): one (observation) matching, using T3/T4 T staging, nodal positivity and ampullary subtype was performed by using the nearest neighbour matching method. Of 736 patients eligible for inclusion, 621 patients were matched of which 458 patients received adjuvant therapy (AT) (predominantly gemcitabine-based) and 163 patients were observed (O). With a median follow-up of 42 months, there was a statistical difference in overall survival in favour of patients receiving AT as compared to those on observation [68.7 months vs. 61.1 months, Hazard ratio: 0.73 (95% CI: 0.54-0.97); p = 0.03]. Besides AT, presence of nodal involvement (median OS: 65.4 months vs not reached; p = 0.04) predicted for inferior OS. The results of the match-pair analysis suggest that adjuvant therapy improves overall survival in periampullary adenocarcinomas at high risk of recurrence with a greater benefit in T3/T4, node-positive and ampullary subtypes. Copyright © 2024 International Hepato-Pancreato-Biliary Association Inc. Published by Elsevier Ltd. All rights reserved.

Citation

Anant Ramaswamy, Vikram Chaudhari, Sujay Srinivas, Prabhat Bhargava, Sadhana Kannan, Ajit Agarwal, Ramakrishnan A Seshadri, Vineet Talwar, Shaifali Goel, Varun Goel, Shivendra Singh, Smita Kayal, Pradeep Rebala, G V Rao, Bharat Prajapati, Devendra Parikh, Jagdish Kothari, Jacob M Kadamapuzha, Hariharan Ramesh, Deeksha Kapoor, Adarsh Chaudhary, Amit Gupta, Anbarasan Sekar, Sanjeev Misra, Jeewan R Vishnoi, Subhash Soni, Vaibhav K Varshney, Sandeep K Bairwa, Joydeep Ghosh, Viraj Lavingia, Manish Bhandare, Shailesh V Shrikhande, Vikas Ostwal. Adjuvant therapy may improve overall survival in high-risk periampullary adenocarcinomas patients - A match-pair analysis from a multi-institutional cohort study (The MIPPAP study). HPB : the official journal of the International Hepato Pancreato Biliary Association. 2024 Oct;26(10):1261-1269