Browsing by Author "Kent, Tara S."

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    Role of Adjuvant Multimodality Therapy After Curative-Intent Resection of Ampullary Carcinoma
    (American Medical Association, 2019-08) Ecker, Brett L.; Vollmer, Charles M., Jr.; Behrman, Stephen W.; Allegrini, Valentina; Aversa, John; Ball, Chad G.; Barrows, Courtney E.; Berger, Adam C.; Cagigas, Martha N.; Christein, John D.; Dixon, Elijah; Fisher, William E.; Freedman-Weiss, Mollie; Guzman-Pruneda, Francisco; Hollis, Robert H.; House, Michael G.; Kent, Tara S.; Kowalsky, Stacy J.; Malleo, Giuseppe; Salem, Ronald R.; Salvia, Roberto; Schmidt, Carl R.; Seykora, Thomas F.; Zheng, Richard; Zureikat, Amer H.; Dickson, Paxton V.; Surgery, School of Medicine
    Importance: Ampullary adenocarcinoma is a rare malignant neoplasm that arises within the duodenal ampullary complex. The role of adjuvant therapy (AT) in the treatment of ampullary adenocarcinoma has not been clearly defined. Objective: To determine if long-term survival after curative-intent resection of ampullary adenocarcinoma may be improved by selection of patients for AT directed by histologic subtype. Design, setting, and participants: This multinational, retrospective cohort study was conducted at 12 institutions from April 1, 2000, to July 31, 2017, among 357 patients with resected, nonmetastatic ampullary adenocarcinoma receiving surgery alone or AT. Cox proportional hazards regression was used to identify covariates associated with overall survival. The surgery alone and AT cohorts were matched 1:1 by propensity scores based on the likelihood of receiving AT or by survival hazard from Cox modeling. Overall survival was compared with Kaplan-Meier estimates. Exposures: Adjuvant chemotherapy (fluorouracil- or gemcitabine-based) with or without radiotherapy. Main outcomes and measures: Overall survival. Results: A total of 357 patients (156 women and 201 men; median age, 65.8 years [interquartile range, 58-74 years]) underwent curative-intent resection of ampullary adenocarcinoma. Patients with intestinal subtype had a longer median overall survival compared with those with pancreatobiliary subtype (77 vs 54 months; P = .05). Histologic subtype was not associated with AT administration (intestinal, 52.9% [101 of 191]; and pancreatobiliary, 59.5% [78 of 131]; P = .24). Patients with pancreatobiliary histologic subtype most commonly received gemcitabine-based regimens (71.0% [22 of 31]) or combinations of gemcitabine and fluorouracil (12.9% [4 of 31]), whereas treatment of those with intestinal histologic subtype was more varied (fluorouracil, 50.0% [17 of 34]; gemcitabine, 44.1% [15 of 34]; P = .01). In the propensity score-matched cohort, AT was not associated with a survival benefit for either histologic subtype (intestinal: hazard ratio, 1.21; 95% CI, 0.67-2.16; P = .53; pancreatobiliary: hazard ratio, 1.35; 95% CI, 0.66-2.76; P = .41). Conclusions and relevance: Adjuvant therapy was more frequently used in patients with poor prognostic factors but was not associated with demonstrable improvements in survival, regardless of tumor histologic subtype. The value of a multimodality regimen remains poorly defined.
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    The road to tailored adjuvant chemotherapy for all four non-pancreatic periampullary cancers: An international multimethod cohort study
    (Springer Nature, 2024) Uijterwijk, Bas A.; Lemmers, Daniël H.; Ghidini, Michele; Wilmink, Johanna W.; Zaniboni, Alberto; Fusai, Giuseppe Kito; Zerbi, Alessandro; Koerkamp, Bas Groot; Luyer, Misha; Ghorbani, Poya; Salvia, Roberto; White, Steven; Ielpo, Benedetto; Goh, Brian K. P.; Boggi, Ugo; Kazemier, Geert; House, Michael G.; Mavroeidis, Vasileios K.; Björnsson, Bergthor; Mazzola, Michele; Serradilla, Mario; Korkolis, Dimitris; Alseidi, Adnan; Roberts, Keith J.; Soonawalla, Zahir; Pessaux, Patrick; Fisher, William E.; Koek, Sharnice; Kent, Tara S.; Vladimirov, Miljana; Bolm, Louisa; Jamieson, Nigel; Dalla Valle, Raffaele; Kleeff, Jorg; Mazzotta, Alessandro; Suarez Muñoz, Miguel Angel; Sánchez Cabús, Santiago; Ball, Chad G.; Berger, Adam C.; Ferarri, Clarissa; Besselink, Marc G.; Hilal, Mohammed Abu; International Study Group on non-pancreatic periampullary Cancer (ISGACA); Surgery, School of Medicine
    Background: Despite differences in tumour behaviour and characteristics between duodenal adenocarcinoma (DAC), the intestinal (AmpIT) and pancreatobiliary (AmpPB) subtype of ampullary adenocarcinoma and distal cholangiocarcinoma (dCCA), the effect of adjuvant chemotherapy (ACT) on these cancers, as well as the optimal ACT regimen, has not been comprehensively assessed. This study aims to assess the influence of tailored ACT on DAC, dCCA, AmpIT, and AmpPB. Patients and methods: Patients after pancreatoduodenectomy for non-pancreatic periampullary adenocarcinoma were identified and collected from 36 tertiary centres between 2010 - 2021. Per non-pancreatic periampullary tumour type, the effect of adjuvant chemotherapy and the main relevant regimens of adjuvant chemotherapy were compared. The primary outcome was overall survival (OS). Results: The study included a total of 2866 patients with DAC (n = 330), AmpIT (n = 765), AmpPB (n = 819), and dCCA (n = 952). Among them, 1329 received ACT, and 1537 did not. ACT was associated with significant improvement in OS for AmpPB (P = 0.004) and dCCA (P < 0.001). Moreover, for patients with dCCA, capecitabine mono ACT provided the greatest OS benefit compared to gemcitabine (P = 0.004) and gemcitabine - cisplatin (P = 0.001). For patients with AmpPB, no superior ACT regime was found (P > 0.226). ACT was not associated with improved OS for DAC and AmpIT (P = 0.113 and P = 0.445, respectively). Discussion: Patients with resected AmpPB and dCCA appear to benefit from ACT. While the optimal ACT for AmpPB remains undetermined, it appears that dCCA shows the most favourable response to capecitabine monotherapy. Tailored adjuvant treatments are essential for enhancing prognosis across all four non-pancreatic periampullary adenocarcinomas.