Potential therapeutic value of primary tumor resection in ampullary cancer patients with distant metastases at initial diagnosis: a population-based study

Abstract

Jie Wang,1,* Xiaobo Bo,1,* Pinxiang Lu,2,* Tao Suo,1 Xiaoling Ni,1 Han Liu,1 Hongtao Pan,1 Sheng Shen,1 Min Li,1 Dexiang Zhang,2 Yueqi Wang,1 Houbao Liu1 1Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China; 2Department of General Surgery, Xuhui Central Hospital, Shanghai, China *These authors contributed equally to this work Objective: To evaluate the therapeutic value of primary tumor resection (PTR) in metastatic ampullary cancer at the initial presentation. Patients and methods: Patients with metastatic ampullary cancer were identified from Surveillance, Epidemiology and End Results database. Propensity score matching (PSM) was performed to balance the characteristics of our cohort. Kaplan–Meier analyses, log-rank tests and multivariate Cox regression models were employed to evaluate the therapeutic value of PTR. Results: A total of 346 patients with metastatic ampullary cancer were identified from 2004 to 2014 and 90 patients were screened by PSM. PTR was associated with favorable overall survival (OS) and cancer-specific survival (CSS) after PSM (PTR vs no-PTR: 16.0, 95% CI: 9.0–22.0 vs 8.0, 95% CI: 5.0–11.0 for median OS; 22.0, 95% CI: 13.0–33.0 vs 9.0, 95% CI: 5.0–11.0 for median CSS; both log-rank P<0.001). Patients receiving PTR plus chemotherapy showed better survival compared with those receiving only chemotherapy (median OS: 18, 95% CI: 13–27 vs 9.0, 95% CI: 8.0–11.0; median CSS: 23.0, 95% CI: 14.0–36.0 vs 9.0, 95% CI: 8.0–13.0; both log-rank P<0.001). Conclusion: PTR might bring a survival benefit to ampullary cancer patients with distant metastasis at the initial presentation and might provide a more favorable prognosis when combined with chemotherapy. Keywords: ampullary cancer, PSM, primary tumor resection, chemotherapy

Keywords

• ampullary cancer
• PSM
• primary tumor resection
• chemotherapy.