1Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
2Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
3Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
Copyright © 2021 by the Korean Cancer Association
This is an Open-Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Ethical Statement
This study was approved by the Institutional Review Board (IRB) of Asan Medical Center (approval number: 2018-1199) and has been confirmed for waiver of informed consent because of the retrospective nature. This study was conducted in accordance with the Declaration of Helsinki and Good Clinical Practice.
Author Contributions
Conceived and designed the analysis: Kim JH, Jeong JH, Ryoo BY, Kim KP, Yoo C, Song KB.
Collected the data: Kim JH, Jeong JH, Ryoo BY, Kim KP, Chang HM, Oh D, Song TJ, Lee SS, Seo DW, Lee SK, Kim MH, Park Y, Kwon JW, Hwang DW, Lee JH, Lee W, Kim SC, Yoo C, Song KB.
Contributed data or analysis tools: Kim JH, Jeong JH, Ryoo BY, Kim KP, Lee SS, Seo DW, Kim MH, Kim SC, Yoo C, Song KB.
Performed the analysis: Kim JH, Jeong JH, Yoo C, Song KB.
Wrote the paper: Kim JH, Yoo C, Song KB.
Conflicts of Interest
Conflict of interest relevant to this article was not reported.
Characteristic | Total patients with AoV cancer (n=646) | Adjuvant chemotherapy (n=165) | No adjuvant chemotherapy (n=481) | p-value |
---|---|---|---|---|
Age (yr) | 62 (35–87) | 61 (39–78) | 63 (35–87) | 0.153 |
Sex | ||||
Male | 350 (54.2) | 101 (61.2) | 249 (51.8) | 0.036 |
Female | 296 (45.8) | 64 (38.8) | 232 (48.2) | |
Tumor size (cm) | 2.1 (0.1–7.0) | 2.25 (0.3–6.0) | 2.04 (0.1–7.0) | 0.033 |
TNM stage | ||||
Stage I | 336 (52.0) | 37 (22.4) | 299 (62.2) | < 0.001 |
Stage II | 114 (17.6) | 44 (26.7) | 70 (14.6) | |
Stage III | 196 (30.3) | 84 (50.9) | 112 (23.3) | |
T category | ||||
T1 | 175 (27.1) | 13 (7.9) | 162 (33.7) | < 0.001 |
T2 | 251 (38.9) | 64 (38.8) | 187 (38.9) | |
T3 | 220 (34.1) | 88 (53.3) | 132 (27.4) | |
N category | ||||
Negative | 450 (69.7) | 81 (49.1) | 369 (76.7) | < 0.001 |
Positive | 196 (30.3) | 84 (50.9) | 112 (23.3) | |
LVI | ||||
Absent | 382 (59.1) | 65 (39.4) | 317 (65.9) | < 0.001 |
Present | 261 (40.4) | 100 (60.6) | 161 (33.5) | |
Unknown | 3 (0.5) | - | 3 (0.6) | |
PNI | ||||
Absent | 474 (73.4) | 104 (63.0) | 370 (76.9) | < 0.001 |
Present | 137 (21.2) | 57 (34.5) | 80 (16.6) | |
Unknown | 35 (5.4) | 4 (2.4) | 31 (6.4) | |
Histology | ||||
W/D | 206 (31.9) | 24 (14.5) | 182 (37.8) | < 0.001 |
M/D | 373 (57.7) | 113 (68.5) | 260 (54.1) | |
P/D | 52 (8.0) | 22 (13.3) | 30 (6.2) | |
Unknown | 15 (2.3) | 6 (3.6) | 9 (1.9) | |
Resection status | ||||
R0 | 633 (98.0) | 162 (98.2) | 471 (97.9) | 0.837 |
R1 | 13 (2.0) | 3 (1.8) | 10 (2.1) | |
Operation type | ||||
PPPD | 643 (99.5) | 164 (99.4) | 479 (99.6) | 0.756 |
TP | 3 (0.5) | 1 (0.6) | 2 (0.4) | |
CEA (ng/mL)a) | ||||
Normal | 483 (74.8) | 125 (75.8) | 358 (74.4) | 0.780 |
Elevated | 58 (9.0) | 16 (9.7) | 42 (8.7) | |
Unknown | 105 (16.3) | 24 (14.5) | 81 (16.8) | |
CA 19-9 (U/mL)a) | ||||
Normal | 405 (62.7) | 87 (52.7) | 318 (66.1) | 0.014 |
Elevated | 191 (29.6) | 59 (35.8) | 132 (27.4) | |
Unknown | 50 (7.7) | 19 (11.5) | 31 (6.4) |
Value are presented as mean (range) or number (%). AoV, ampulla of Vater; CA 19-9, carbohydrate antigen 19-9; CEA, carcinoembryonic antigen; LVI, lymphovascular invasion; M/D, moderately differentiated; P/D, poorly differentiated; PNI, perineural invasion; PPPD, pylorus-preserving pancreaticoduodenectomy; TP, total pancreatectomy; W/D, well differentiated.
a) The levels of CEA and CA 19-9 were evaluated before operation.
Variable | Univariate analysis | Multivariate analysis | ||
---|---|---|---|---|
|
|
|||
HR (95% CI) | p-value | HR (95% CI) | p-value | |
Age (> 60 yr vs. ≤ 60 yr) | 1.30 (1.04–1.64) | 0.022 | - | - |
|
||||
Sex (male vs. female) | 1.33 (1.06–1.67) | 0.013 | - | - |
|
||||
Group (adjuvant chemotherapy vs. no adjuvant chemotherapy) | 1.53 (1.20–2.00) | 0.001 | 0.74 (0.54–1.00) | 0.052 |
|
||||
TNM stage | ||||
|
||||
Stage I | 1 | < 0.001 | 1 | < 0.001 |
|
||||
Stage II | 2.59 (1.90–3.52) | 2.36 (1.59–3.49) | ||
|
||||
Stage III | 4.14 (3.20–5.36) | 3.30 (2.33–4.67) | ||
|
||||
Resection status (R1 vs. R0) | 2.58 (1.41–4.72) | 0.002 | 2.03 (1.07–3.86) | 0.030 |
|
||||
LVI (present vs. absent) | 3.00 (2.39–3.76) | < 0.001 | 2.18 (1.62–2.95) | < 0.001 |
|
||||
PNI (present vs. absent) | 2.50 (1.95–3.19) | < 0.001 | 1.54 (1.14–2.07) | 0.005 |
|
||||
Histology | ||||
|
||||
W/D | 1 ( | < 0.001 | - | - |
|
||||
M/D | 2.60 (1.96–3.47) | - | ||
|
||||
P/D | 2.59 (1.65–4.05) | - | ||
|
||||
CA 19-9 (> 37.0 U/mL vs. < 37.0 U/mL)a) | 1.79 (1.41–2.27) | < 0.001 | - | - |
|
||||
CEA (> 5.0 ng/mL vs. < 5.0 ng/mL)a) | 1.78 (1.25–2.52) | 0.001 | - | - |
CA 19-9, carbohydrate antigen 19-9; CEA, carcinoembryonic antigen; CI, confidence interval; HR, hazard ratio; LVI, lymphovascular invasion; M/D, moderately differentiated; P/D, poorly differentiated; PNI, perineural invasion; W/D, well differentiated.
a) The levels of CEA and CA 19-9 were evaluated before operation.
Variable | Univariate analysis | Multivariate analysis | ||
---|---|---|---|---|
|
|
|||
HR (95% CI) | p-value | HR (95% CI) | p-value | |
Age (> 60 yr vs. ≤ 60 yr) | 1.25 (0.97–1.59) | 0.077 | - | - |
|
||||
Sex (male vs. female) | 1.43 (1.12–1.83) | 0.004 | - | - |
|
||||
Group (adjuvant chemotherapy vs. no adjuvant chemotherapy) | 1.49 (1.14–1.95) | 0.003 | - | - |
|
||||
TNM stage | ||||
|
||||
Stage I | 1 | < 0.001 | 1 | < 0.001 |
|
||||
Stage II | 2.57 (1.83–3.59) | 2.04 (1.33–3.14) | ||
|
||||
Stage III | 4.29 (3.25–5.67) | 3.08 (2.12–4.47) | ||
|
||||
Resection status (R1 vs. R0) | 2.71 (1.44–5.09) | 0.002 | 2.07 (1.06–4.07) | 0.034 |
|
||||
LVI (present vs. absent) | 2.72 (2.13–3.46) | < 0.001 | 1.74 (1.26–2.40) | 0.001 |
|
||||
PNI (present vs. absent) | 2.66 (2.05–3.46) | < 0.001 | 1.76 (1.28–2.44) | 0.001 |
|
||||
Histology | ||||
|
||||
W/D | 1 ( | < 0.001 | - | - |
|
||||
M/D | 2.72 (1.98–3.72) | - | ||
|
||||
P/D | 2.75 (1.70–4.45) | - | ||
|
||||
CA 19-9 (> 37.0 U/mL vs. < 37.0 U/mL)a) | 1.70 (1.32–2.19) | < 0.001 | - | - |
|
||||
CEA (> 5.0 ng/mL vs. < 5.0 ng/mL)a) | 1.62 (1.10–2.39) | 0.014 | - | - |
CA 19-9, carbohydrate antigen 19-9; CEA, carcinoembryonic antigen; CI, confidence interval; HR, hazard ratio; LVI, lymphovascular invasion; M/D, moderately differentiated; P/D, poorly differentiated; PNI, perineural invasion; W/D, well differentiated.
a) The levels of CEA and CA 19-9 were evaluated before operation.
Recurrence-free survival | Overall survival | |||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
|
|
|||||||||||
Unmatched sample | Matched sample | Unmatched sample | Matched sample | |||||||||
|
|
|
|
|||||||||
Unadjusted HR (95% CI) | p-value | Adjusted (95% CI) | p-value | HRa) (95% CI) | p-value | Unadjusted HR (95% CI) | p-value | Adjusted (95% CI) | p-value | HRa) (95% CI) | p-value | |
Adjuvant chemotherapy | ||||||||||||
|
||||||||||||
No | 1 | 1 | 1 | 1 | 1 | 1 | ||||||
|
||||||||||||
Yes | 0.90 (0.68–1.19) | 0.462 | 0.73 (0.54–0.97) | 0.033 | 0.80 (0.60–1.06) | 0.116 | 0.93 (0.69–1.26) | 0.646 | 0.78 (0.57–1.07) | 0.129 | 0.77 (0.56–1.06) | 0.111 |
|
||||||||||||
Age (yr) | ||||||||||||
|
||||||||||||
≤ 60 | 1 | 1 | 1 | 1 | ||||||||
|
||||||||||||
> 60 | 1.25 (0.94–1.66) | 0.129 | 1.22 (0.92–1.62) | 0.177 | 1.17 (0.87–1.57) | 0.310 | 1.20 (0.88–1.62) | 0.245 | ||||
|
||||||||||||
Sex | ||||||||||||
|
||||||||||||
Female | 1 | 1 | 1 | 1 | ||||||||
|
||||||||||||
Male | 1.19 (0.90–1.58) | 0.226 | 1.04 (0.78–1.39) | 0.801 | 1.25 (0.93–1.70) | 0.143 | 1.11 (0.81–1.51) | 0.518 | ||||
|
||||||||||||
Stage | ||||||||||||
|
||||||||||||
Stage II | 1 | 1 | 1 | 1 | ||||||||
|
||||||||||||
Stage III | 1.58 (1.18–2.13) | 0.002 | 1.36 (0.99–1.87) | 0.054 | 1.67 (1.21–2.30) | 0.002 | 1.53 (1.09–2.15) | 0.015 | ||||
|
||||||||||||
LVI | ||||||||||||
|
||||||||||||
Absent | 1 | 1 | 1 | 1 | ||||||||
|
||||||||||||
Present | 2.45 (1.81–3.32) | < 0.001 | 2.21 (1.56–3.13) | < 0.001 | 2.28 (1.66–3.14) | <0.001 | 1.86 (1.30–2.68) | 0.001 | ||||
|
||||||||||||
PNI | ||||||||||||
|
||||||||||||
Absent | 1 | 1 | 1 | 1 | ||||||||
|
||||||||||||
Present | 1.63 (1.23–2.15) | 0.001 | 1.50 (1.11–2.01) | 0.008 | 1.67 (1.25–2.25) | 0.001 | 1.64 (1.20–2.24) | 0.002 | ||||
|
||||||||||||
Histology | ||||||||||||
|
||||||||||||
W/D | 1 | 1 | 1 | 1 | ||||||||
|
||||||||||||
M/D | 1.53 (0.98–2.39) | 0.064 | 0.98 (0.60–1.61) | 0.948 | 1.54 (0.96–2.49) | 0.076 | 1.14 (0.68–1.93) | 0.616 | ||||
|
||||||||||||
P/D | 1.43 (0.80–2.55) | 0.226 | 1.05 (0.57–1.92) | 0.876 | 1.38 (0.74–2.57) | 0.310 | 1.08 (0.57–2.06) | 0.811 | ||||
|
||||||||||||
Resection status | ||||||||||||
|
||||||||||||
R0 | 1 | 1 | 1 | 1 | ||||||||
|
||||||||||||
R1 | 1.77 (0.87–3.58) | 0.115 | 1.68 (0.82–3.47) | 0.159 | 1.70 (0.80–3.62) | 0.168 | 1.57 (0.72–3.41) | 0.252 | ||||
|
||||||||||||
CA19-9 (U/mL) | ||||||||||||
|
||||||||||||
Normal | 1 | 1 | 1 | 1 | ||||||||
|
||||||||||||
Elevated | 1.43 (1.08–1.88) | 0.012 | 1.27 (0.96–1.70) | 0.097 | 1.30 (0.97–1.75) | 0.075 | 1.15 (0.84–1.56) | 0.384 |
CA 19-9, carbohydrate antigen 19-9; CI, confidence interval; HR, hazard ratio; LVI, lymphovascular invasion; M/D, moderately differentiated; P/D, poorly differentiated; PNI, perineural invasion; W/D, well differentiated.
a) Univariate Cox regression model was used with robust variance estimation to account for clustering by matched pairs.
Recurrencea) (n=265, %) | Adjuvant chemotherapy group (n=86, %) | No adjuvant chemotherapy group (n=179, %) | |
---|---|---|---|
Locoregional recurrence | 37 (14.0) | 11 (12.8) | 26 (14.5) |
Systemic recurrence | 228 (86.0) | 75 (87.2) | 153 (85.5) |
Locoregional recurrence in 37 patients (multiple sites) | |||
Operation or anastomosis sites | 15 | 6 | 9 |
Regional lymph nodes | 25 | 7 | 18 |
Systemic recurrence in 228 patients (multiple sites) | |||
Distant lymph nodes | 77 | 25 | 52 |
Liver | 145 | 42 | 103 |
Lung | 81 | 24 | 57 |
Peritoneum | 49 | 16 | 33 |
Bone | 17 | 6 | 11 |
Remnant pancreas | 7 | 1 | 6 |
Adrenal | 3 | 1 | 2 |
Brain | 1 | 1 | 0 |
a) Among 27 patients with recurrence after concurrent chemoradiation (CCRT), 2 (7.4%) patients and 25 patients (92.6%) presented initially with locoregional and systemic recurrence, respectively.
There were no significant differences in locoregional (12.8% vs. 14.5%) and systemic recurrence (87.2% vs. 85.5%) between adjuvant chemotherapy and no adjuvant chemotherapy groups (p=0.703). There were no significant differences in locoregional reccurence rates (7.4% vs. 14.7%) between patients treated with CCRT and without CCRT (p=0.392).
Baseline characteristics of the patients
Characteristic | Total patients with AoV cancer (n=646) | Adjuvant chemotherapy (n=165) | No adjuvant chemotherapy (n=481) | p-value |
---|---|---|---|---|
Age (yr) | 62 (35–87) | 61 (39–78) | 63 (35–87) | 0.153 |
Sex | ||||
Male | 350 (54.2) | 101 (61.2) | 249 (51.8) | 0.036 |
Female | 296 (45.8) | 64 (38.8) | 232 (48.2) | |
Tumor size (cm) | 2.1 (0.1–7.0) | 2.25 (0.3–6.0) | 2.04 (0.1–7.0) | 0.033 |
TNM stage | ||||
Stage I | 336 (52.0) | 37 (22.4) | 299 (62.2) | < 0.001 |
Stage II | 114 (17.6) | 44 (26.7) | 70 (14.6) | |
Stage III | 196 (30.3) | 84 (50.9) | 112 (23.3) | |
T category | ||||
T1 | 175 (27.1) | 13 (7.9) | 162 (33.7) | < 0.001 |
T2 | 251 (38.9) | 64 (38.8) | 187 (38.9) | |
T3 | 220 (34.1) | 88 (53.3) | 132 (27.4) | |
N category | ||||
Negative | 450 (69.7) | 81 (49.1) | 369 (76.7) | < 0.001 |
Positive | 196 (30.3) | 84 (50.9) | 112 (23.3) | |
LVI | ||||
Absent | 382 (59.1) | 65 (39.4) | 317 (65.9) | < 0.001 |
Present | 261 (40.4) | 100 (60.6) | 161 (33.5) | |
Unknown | 3 (0.5) | - | 3 (0.6) | |
PNI | ||||
Absent | 474 (73.4) | 104 (63.0) | 370 (76.9) | < 0.001 |
Present | 137 (21.2) | 57 (34.5) | 80 (16.6) | |
Unknown | 35 (5.4) | 4 (2.4) | 31 (6.4) | |
Histology | ||||
W/D | 206 (31.9) | 24 (14.5) | 182 (37.8) | < 0.001 |
M/D | 373 (57.7) | 113 (68.5) | 260 (54.1) | |
P/D | 52 (8.0) | 22 (13.3) | 30 (6.2) | |
Unknown | 15 (2.3) | 6 (3.6) | 9 (1.9) | |
Resection status | ||||
R0 | 633 (98.0) | 162 (98.2) | 471 (97.9) | 0.837 |
R1 | 13 (2.0) | 3 (1.8) | 10 (2.1) | |
Operation type | ||||
PPPD | 643 (99.5) | 164 (99.4) | 479 (99.6) | 0.756 |
TP | 3 (0.5) | 1 (0.6) | 2 (0.4) | |
CEA (ng/mL) | ||||
Normal | 483 (74.8) | 125 (75.8) | 358 (74.4) | 0.780 |
Elevated | 58 (9.0) | 16 (9.7) | 42 (8.7) | |
Unknown | 105 (16.3) | 24 (14.5) | 81 (16.8) | |
CA 19-9 (U/mL) | ||||
Normal | 405 (62.7) | 87 (52.7) | 318 (66.1) | 0.014 |
Elevated | 191 (29.6) | 59 (35.8) | 132 (27.4) | |
Unknown | 50 (7.7) | 19 (11.5) | 31 (6.4) |
Value are presented as mean (range) or number (%). AoV, ampulla of Vater; CA 19-9, carbohydrate antigen 19-9; CEA, carcinoembryonic antigen; LVI, lymphovascular invasion; M/D, moderately differentiated; P/D, poorly differentiated; PNI, perineural invasion; PPPD, pylorus-preserving pancreaticoduodenectomy; TP, total pancreatectomy; W/D, well differentiated.
a)The levels of CEA and CA 19-9 were evaluated before operation.
Univariate and multivariate analysis of recurrence-free survival
Variable | Univariate analysis | Multivariate analysis | ||
---|---|---|---|---|
|
| |||
HR (95% CI) | p-value | HR (95% CI) | p-value | |
Age (> 60 yr vs. ≤ 60 yr) | 1.30 (1.04–1.64) | 0.022 | - | - |
| ||||
Sex (male vs. female) | 1.33 (1.06–1.67) | 0.013 | - | - |
| ||||
Group (adjuvant chemotherapy vs. no adjuvant chemotherapy) | 1.53 (1.20–2.00) | 0.001 | 0.74 (0.54–1.00) | 0.052 |
| ||||
TNM stage | ||||
| ||||
Stage I | 1 | < 0.001 | 1 | < 0.001 |
| ||||
Stage II | 2.59 (1.90–3.52) | 2.36 (1.59–3.49) | ||
| ||||
Stage III | 4.14 (3.20–5.36) | 3.30 (2.33–4.67) | ||
| ||||
Resection status (R1 vs. R0) | 2.58 (1.41–4.72) | 0.002 | 2.03 (1.07–3.86) | 0.030 |
| ||||
LVI (present vs. absent) | 3.00 (2.39–3.76) | < 0.001 | 2.18 (1.62–2.95) | < 0.001 |
| ||||
PNI (present vs. absent) | 2.50 (1.95–3.19) | < 0.001 | 1.54 (1.14–2.07) | 0.005 |
| ||||
Histology | ||||
| ||||
W/D | 1 ( | < 0.001 | - | - |
| ||||
M/D | 2.60 (1.96–3.47) | - | ||
| ||||
P/D | 2.59 (1.65–4.05) | - | ||
| ||||
CA 19-9 (> 37.0 U/mL vs. < 37.0 U/mL) |
1.79 (1.41–2.27) | < 0.001 | - | - |
| ||||
CEA (> 5.0 ng/mL vs. < 5.0 ng/mL) |
1.78 (1.25–2.52) | 0.001 | - | - |
CA 19-9, carbohydrate antigen 19-9; CEA, carcinoembryonic antigen; CI, confidence interval; HR, hazard ratio; LVI, lymphovascular invasion; M/D, moderately differentiated; P/D, poorly differentiated; PNI, perineural invasion; W/D, well differentiated.
a)The levels of CEA and CA 19-9 were evaluated before operation.
Univariate and multivariate analysis of overall survival
Variable | Univariate analysis | Multivariate analysis | ||
---|---|---|---|---|
|
| |||
HR (95% CI) | p-value | HR (95% CI) | p-value | |
Age (> 60 yr vs. ≤ 60 yr) | 1.25 (0.97–1.59) | 0.077 | - | - |
| ||||
Sex (male vs. female) | 1.43 (1.12–1.83) | 0.004 | - | - |
| ||||
Group (adjuvant chemotherapy vs. no adjuvant chemotherapy) | 1.49 (1.14–1.95) | 0.003 | - | - |
| ||||
TNM stage | ||||
| ||||
Stage I | 1 | < 0.001 | 1 | < 0.001 |
| ||||
Stage II | 2.57 (1.83–3.59) | 2.04 (1.33–3.14) | ||
| ||||
Stage III | 4.29 (3.25–5.67) | 3.08 (2.12–4.47) | ||
| ||||
Resection status (R1 vs. R0) | 2.71 (1.44–5.09) | 0.002 | 2.07 (1.06–4.07) | 0.034 |
| ||||
LVI (present vs. absent) | 2.72 (2.13–3.46) | < 0.001 | 1.74 (1.26–2.40) | 0.001 |
| ||||
PNI (present vs. absent) | 2.66 (2.05–3.46) | < 0.001 | 1.76 (1.28–2.44) | 0.001 |
| ||||
Histology | ||||
| ||||
W/D | 1 ( | < 0.001 | - | - |
| ||||
M/D | 2.72 (1.98–3.72) | - | ||
| ||||
P/D | 2.75 (1.70–4.45) | - | ||
| ||||
CA 19-9 (> 37.0 U/mL vs. < 37.0 U/mL) |
1.70 (1.32–2.19) | < 0.001 | - | - |
| ||||
CEA (> 5.0 ng/mL vs. < 5.0 ng/mL) |
1.62 (1.10–2.39) | 0.014 | - | - |
CA 19-9, carbohydrate antigen 19-9; CEA, carcinoembryonic antigen; CI, confidence interval; HR, hazard ratio; LVI, lymphovascular invasion; M/D, moderately differentiated; P/D, poorly differentiated; PNI, perineural invasion; W/D, well differentiated.
a)The levels of CEA and CA 19-9 were evaluated before operation.
Univariate and multivariate analysis of recurrence-free survival and overall survival of stage II/III patients in the unmatched and matched samples
Recurrence-free survival | Overall survival | |||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
|
| |||||||||||
Unmatched sample | Matched sample | Unmatched sample | Matched sample | |||||||||
|
|
|
| |||||||||
Unadjusted HR (95% CI) | p-value | Adjusted (95% CI) | p-value | HR |
p-value | Unadjusted HR (95% CI) | p-value | Adjusted (95% CI) | p-value | HR |
p-value | |
Adjuvant chemotherapy | ||||||||||||
| ||||||||||||
No | 1 | 1 | 1 | 1 | 1 | 1 | ||||||
| ||||||||||||
Yes | 0.90 (0.68–1.19) | 0.462 | 0.73 (0.54–0.97) | 0.033 | 0.80 (0.60–1.06) | 0.116 | 0.93 (0.69–1.26) | 0.646 | 0.78 (0.57–1.07) | 0.129 | 0.77 (0.56–1.06) | 0.111 |
| ||||||||||||
Age (yr) | ||||||||||||
| ||||||||||||
≤ 60 | 1 | 1 | 1 | 1 | ||||||||
| ||||||||||||
> 60 | 1.25 (0.94–1.66) | 0.129 | 1.22 (0.92–1.62) | 0.177 | 1.17 (0.87–1.57) | 0.310 | 1.20 (0.88–1.62) | 0.245 | ||||
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Sex | ||||||||||||
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Female | 1 | 1 | 1 | 1 | ||||||||
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Male | 1.19 (0.90–1.58) | 0.226 | 1.04 (0.78–1.39) | 0.801 | 1.25 (0.93–1.70) | 0.143 | 1.11 (0.81–1.51) | 0.518 | ||||
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Stage | ||||||||||||
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Stage II | 1 | 1 | 1 | 1 | ||||||||
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Stage III | 1.58 (1.18–2.13) | 0.002 | 1.36 (0.99–1.87) | 0.054 | 1.67 (1.21–2.30) | 0.002 | 1.53 (1.09–2.15) | 0.015 | ||||
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LVI | ||||||||||||
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Absent | 1 | 1 | 1 | 1 | ||||||||
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Present | 2.45 (1.81–3.32) | < 0.001 | 2.21 (1.56–3.13) | < 0.001 | 2.28 (1.66–3.14) | <0.001 | 1.86 (1.30–2.68) | 0.001 | ||||
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PNI | ||||||||||||
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Absent | 1 | 1 | 1 | 1 | ||||||||
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Present | 1.63 (1.23–2.15) | 0.001 | 1.50 (1.11–2.01) | 0.008 | 1.67 (1.25–2.25) | 0.001 | 1.64 (1.20–2.24) | 0.002 | ||||
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Histology | ||||||||||||
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W/D | 1 | 1 | 1 | 1 | ||||||||
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M/D | 1.53 (0.98–2.39) | 0.064 | 0.98 (0.60–1.61) | 0.948 | 1.54 (0.96–2.49) | 0.076 | 1.14 (0.68–1.93) | 0.616 | ||||
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P/D | 1.43 (0.80–2.55) | 0.226 | 1.05 (0.57–1.92) | 0.876 | 1.38 (0.74–2.57) | 0.310 | 1.08 (0.57–2.06) | 0.811 | ||||
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Resection status | ||||||||||||
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R0 | 1 | 1 | 1 | 1 | ||||||||
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R1 | 1.77 (0.87–3.58) | 0.115 | 1.68 (0.82–3.47) | 0.159 | 1.70 (0.80–3.62) | 0.168 | 1.57 (0.72–3.41) | 0.252 | ||||
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CA19-9 (U/mL) | ||||||||||||
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Normal | 1 | 1 | 1 | 1 | ||||||||
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Elevated | 1.43 (1.08–1.88) | 0.012 | 1.27 (0.96–1.70) | 0.097 | 1.30 (0.97–1.75) | 0.075 | 1.15 (0.84–1.56) | 0.384 |
CA 19-9, carbohydrate antigen 19-9; CI, confidence interval; HR, hazard ratio; LVI, lymphovascular invasion; M/D, moderately differentiated; P/D, poorly differentiated; PNI, perineural invasion; W/D, well differentiated.
a)Univariate Cox regression model was used with robust variance estimation to account for clustering by matched pairs.
Recurrence sites between adjuvant chemotherapy and no adjuvant chemotherapy groups in 265 patients with recurrence
Recurrence |
Adjuvant chemotherapy group (n=86, %) | No adjuvant chemotherapy group (n=179, %) | |
---|---|---|---|
Locoregional recurrence | 37 (14.0) | 11 (12.8) | 26 (14.5) |
Systemic recurrence | 228 (86.0) | 75 (87.2) | 153 (85.5) |
Locoregional recurrence in 37 patients (multiple sites) | |||
Operation or anastomosis sites | 15 | 6 | 9 |
Regional lymph nodes | 25 | 7 | 18 |
Systemic recurrence in 228 patients (multiple sites) | |||
Distant lymph nodes | 77 | 25 | 52 |
Liver | 145 | 42 | 103 |
Lung | 81 | 24 | 57 |
Peritoneum | 49 | 16 | 33 |
Bone | 17 | 6 | 11 |
Remnant pancreas | 7 | 1 | 6 |
Adrenal | 3 | 1 | 2 |
Brain | 1 | 1 | 0 |
a)Among 27 patients with recurrence after concurrent chemoradiation (CCRT), 2 (7.4%) patients and 25 patients (92.6%) presented initially with locoregional and systemic recurrence, respectively.
There were no significant differences in locoregional (12.8% vs. 14.5%) and systemic recurrence (87.2% vs. 85.5%) between adjuvant chemotherapy and no adjuvant chemotherapy groups (p=0.703). There were no significant differences in locoregional reccurence rates (7.4% vs. 14.7%) between patients treated with CCRT and without CCRT (p=0.392).
Value are presented as mean (range) or number (%). AoV, ampulla of Vater; CA 19-9, carbohydrate antigen 19-9; CEA, carcinoembryonic antigen; LVI, lymphovascular invasion; M/D, moderately differentiated; P/D, poorly differentiated; PNI, perineural invasion; PPPD, pylorus-preserving pancreaticoduodenectomy; TP, total pancreatectomy; W/D, well differentiated. The levels of CEA and CA 19-9 were evaluated before operation.
CA 19-9, carbohydrate antigen 19-9; CEA, carcinoembryonic antigen; CI, confidence interval; HR, hazard ratio; LVI, lymphovascular invasion; M/D, moderately differentiated; P/D, poorly differentiated; PNI, perineural invasion; W/D, well differentiated. The levels of CEA and CA 19-9 were evaluated before operation.
CA 19-9, carbohydrate antigen 19-9; CEA, carcinoembryonic antigen; CI, confidence interval; HR, hazard ratio; LVI, lymphovascular invasion; M/D, moderately differentiated; P/D, poorly differentiated; PNI, perineural invasion; W/D, well differentiated. The levels of CEA and CA 19-9 were evaluated before operation.
CA 19-9, carbohydrate antigen 19-9; CI, confidence interval; HR, hazard ratio; LVI, lymphovascular invasion; M/D, moderately differentiated; P/D, poorly differentiated; PNI, perineural invasion; W/D, well differentiated. Univariate Cox regression model was used with robust variance estimation to account for clustering by matched pairs.
Among 27 patients with recurrence after concurrent chemoradiation (CCRT), 2 (7.4%) patients and 25 patients (92.6%) presented initially with locoregional and systemic recurrence, respectively. There were no significant differences in locoregional (12.8% vs. 14.5%) and systemic recurrence (87.2% vs. 85.5%) between adjuvant chemotherapy and no adjuvant chemotherapy groups (p=0.703). There were no significant differences in locoregional reccurence rates (7.4% vs. 14.7%) between patients treated with CCRT and without CCRT (p=0.392).