THE ROLE OF NEOADJUVANT VERSUS ADJUVANT THERAPY FOR DUODENAL ADENOCARCINOMA: A NATIONAL CANCER DATABASE (NCDB) PROPENSITY SCORE MATCHED ANALYSIS
Kimberly M. Linden*, Atlee M. Melillo, Gaughan John, Chioma G. Obinero, Umur Atabek, Francis Spitz, Young Hong
General Surgery, Cooper University Hospital, Camden, PA
Introduction: Duodenal adenocarcinoma is currently the most common malignant neoplasm of the small bowel. While adjuvant therapy is recommended after surgical resection of duodenal adenocarcinoma, the role of neoadjuvant therapy remains undefined. We hypothesized neoadjuvant therapy would have improved overall survival, decreased 30-day and 90-day mortality versus patients receiving surgery followed by adjuvant therapy after propensity score matching for duodenal adenocarcinoma.
Methods: A retrospective study using the National Cancer Database (NCDB) was performed to identify patients with duodenal adenocarcinoma from 2004 to 2014 who received either adjuvant or neoadjuvant therapy. Univariate patient factors of age, sex, race, Hispanic origin, insurance status, income, education, Charlson Comorbidity Index, tumor size and stage were used to perform propensity score matching. Multivariate analysis was used to determine the independent variable for outcomes affecting the 30-day and 90-day mortality as well as overall survival data at 1 year, 3 year, and 5 years.
Results: There was a total of 112 patients with duodenal adenocarcinoma with 57 patients receiving adjuvant therapy and 55 patients receiving neoadjuvant therapy. There was no statistically significant difference in 30-day (0% vs 1.75%; p = 1.00) or 90-day mortality (1.82% vs 7.02%; p = 0.3640) between adjuvant and neoadjuvant therapy, respectively. Duodenal adenocarcinoma treated with adjuvant chemotherapy following surgical resection had a trend towards a higher 1-year, 3-year and 5-year survival compared to neoadjuvant (1yr: 86% vs. 76; 3yr: 49% vs. 46%; 5yr: 42% vs. 39%; p = 0.3914). Multivariate analysis revealed stage was an independent predictor of decreased overall survival (hazard ratio 1.47, 95% CI 1.077, 2.007).
Conclusions: While there have been indications that neoadjuvant therapy my be benificital in other periampullary tumors, there was no statistically significant difference for overall survival at 1 year, 3 years, and 5 years between neoadjuvant chemotherapy versus adjuvant chemotherapy for patients with resectable duodenal adenocarcinoma after retrospective propensity score matched analysis.
Figure 1: Survival probability of neoadjuvant vs. adjuvant chemotherapy for duodenal adenocarcinoma after propensity score matching analysis adjusting for of age, sex, race, Hispanic origin, insurance status, income, education, Charlson Comorbidity Index, tumor size and stage.
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