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Impact of adjuvant chemotherapy after pancreaticoduodenectomy for distal cholangiocarcinoma: a propensity score analysis from a French multicentric cohort

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Abstract

Background

The benefit of adjuvant chemotherapy (AC) after pancreaticoduodenectomy (PD) for distal cholangiocarcinoma (DCC) remains controversial. The study aimed to evaluate the impact of AC after PD for DCC in a large multicentric cohort.

Methods

Patients from five French centers who underwent from PD for DCC between 2000 and 2015 and received AC (AC+ group) or surgery only (AC− group) were included in the analysis. Variables associated with AC administration were analyzed by univariate analysis. The Cox regression identified covariates associated with overall survival (OS) and disease-free survival (DFS). The AC+ cohort was matched to the AC− cohort (1:1) by a propensity score (PS) based on the likelihood of AC administration and independent factors associated with decreased OS and DFS.

Results

Of the 178 patients included, 56 (31.5%) received AC. In the whole cohort, no difference on OS and DFS between the AC+ and AC− groups was identified (P = 0.15 and P = 0.07, respectively). After PS matching, the AC+ group (n = 49) was comparable to the AC− group (n = 49) on factors associated with AC administration and on factors associated with a decreased survival in the large cohort. After matching, the medians of OS and DFS in the AC+ group and in the AC− group were comparable (26.27 vs 43.33 months, P = 0.34, and 15.47 vs. 14.70 months, P = 0.79, respectively).

Conclusion

Our study did not demonstrate a survival benefit of adjuvant chemotherapy (mostly base on gemcitabine regimen) for DCC after PD even after propensity score matching. New trial specially designed for DCC is urgently needed to improve survival after surgical resection.

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Abbreviations

DCC:

Distal cholangiocarcinoma

PD:

Pancreaticoduodenectomy

AC:

Adjuvant chemotherapy

RCT:

Randomized control trial

ASA:

American Society of Anesthesiologists

BMI:

Body mass index

IQR:

Interquartile range

OS:

Overall survival

DFS:

Disease-free survival

PDAC:

Pancreatic ductal adenocarcinoma

ACRT:

Adjuvant chemoradiotherapy

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Author information

Authors and Affiliations

  1. Department of HPB and Digestive Surgery, Pontchaillou Hospital, CHU Rennes, Rennes, France

    Damien Bergeat, Laetitia Courtin-Tanguy & Laurent Sulpice

  2. Rennes 1 University, Rennes, France

    Damien Bergeat, Laetitia Courtin-Tanguy & Laurent Sulpice

  3. INRA, UR1341 ADNC, St Gilles, France

    Damien Bergeat

  4. Department of Surgical Oncology, Institut Paoli-Calmettes, Marseille, France

    Olivier Turrini & Jean Robert Delpero

  5. Department of Digestive Surgery and Transplantation, CHRU de Lille, Lille, France

    Stéphanie Truant

  6. Department of General Surgery and Liver Transplantation, Hospices Civils de Lyon, Croix-Rousse University Hospital, Lyon, France

    Benjamin Darnis & Jean-Yves Mabrut

  7. Department of Digestive Surgery, Nantes University Hospital, Nantes, France

    Nicolas Regenet

  8. UMR991 Liver Metabolism and Cancer, Inserm, Rennes, France

    Laurent Sulpice

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  1. Damien Bergeat
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Contributions

Study concept and design: DB and LS. Acquisition of data: LCT, BD, ST, and NR. Analysis and interpretation of data: DB and LS. Drafting of the manuscript: DB and LS. Critical revision of the manuscript for important intellectual content: JRD, JYM, LS, NR, BD, and ST. Statistical analysis: DB and LCT.

Corresponding author

Correspondence to Laurent Sulpice.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

For this type of study, formal consent is not required but the clinical data were retrospectively collected from a liver resection database and analyzed after institutional review board approval was obtained.

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Fig. S1

Recurrences characteristics (DOCX 50 kb)

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Bergeat, D., Turrini, O., Courtin-Tanguy, L. et al. Impact of adjuvant chemotherapy after pancreaticoduodenectomy for distal cholangiocarcinoma: a propensity score analysis from a French multicentric cohort. Langenbecks Arch Surg 403, 701–709 (2018). https://doi.org/10.1007/s00423-018-1702-1

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