Abstract：
BACKGROUND: The efficacy of adjuvant treatment (AT) in ampullary cancer (AmC) remains controversial. This systematic review and meta-analysis aimed to evaluate the role of AT for AmC.
METHODS: A comprehensive systematic search was performed in PubMed, EMBASE, Cochrane Library, and Web of Science databases. Studies comparing overall survival (OS) and recurrence-free survival (RFS) of patients who underwent AT or not following AmC resection were included.
RESULTS: A total of 3971 patients in 21 studies were analyzed. Overall pooled data showed no significant difference in effect on the OS by AT [hazard ratio (HR) = 0.998, 95% confidence interval (CI): 0.768-1.297]. No significant difference in recurrence between the AT and non-AT (nAT) groups was noted (HR = 1.158, 95% CI: 0.764-1.755). In subgroup analysis, patients who received AT showed favorable outcomes in the OS compared with those who received nAT in nodal-positive AmC (HR = 0.627, 95% CI: 0.451-0.870). Neither AT consisted of adjuvant chemotherapy with radiotherapy (HR = 0.804, 95% CI: 0.563-1.149) nor AT with adjuvant chemotherapy (HR = 0.883, 95% CI: 0.642-1.214) showed any significant effect on the OS.
CONCLUSIONS: The effect of AT in AmC on survival and recurrence did not show a significant benefit. Furthermore, effectiveness according to AT strategies did not show enhancement in survival. AT had an advantage in survival compared with nAT strategy in nodal-positive AmC. In cases of AmC with positive lymph nodal involvement, AT may be warranted regardless of detailed strategies.
METHODS: A comprehensive systematic search was performed in PubMed, EMBASE, Cochrane Library, and Web of Science databases. Studies comparing overall survival (OS) and recurrence-free survival (RFS) of patients who underwent AT or not following AmC resection were included.
RESULTS: A total of 3971 patients in 21 studies were analyzed. Overall pooled data showed no significant difference in effect on the OS by AT [hazard ratio (HR) = 0.998, 95% confidence interval (CI): 0.768-1.297]. No significant difference in recurrence between the AT and non-AT (nAT) groups was noted (HR = 1.158, 95% CI: 0.764-1.755). In subgroup analysis, patients who received AT showed favorable outcomes in the OS compared with those who received nAT in nodal-positive AmC (HR = 0.627, 95% CI: 0.451-0.870). Neither AT consisted of adjuvant chemotherapy with radiotherapy (HR = 0.804, 95% CI: 0.563-1.149) nor AT with adjuvant chemotherapy (HR = 0.883, 95% CI: 0.642-1.214) showed any significant effect on the OS.
CONCLUSIONS: The effect of AT in AmC on survival and recurrence did not show a significant benefit. Furthermore, effectiveness according to AT strategies did not show enhancement in survival. AT had an advantage in survival compared with nAT strategy in nodal-positive AmC. In cases of AmC with positive lymph nodal involvement, AT may be warranted regardless of detailed strategies.
摘要：
背景：壶腹癌（AmC）辅助治疗（AT）的疗效仍存在争议。本系统评价和荟萃分析旨在评估AT对AmC的作用。
方法：在PubMed中进行了全面的系统搜索，EMBASE,科克伦图书馆,和WebofScience数据库。包括比较AmC切除术后接受AT或未接受AT的患者的总生存期（OS）和无复发生存期（RFS）的研究。
结果：共分析了21项研究中的3971例患者。总体汇总数据显示AT对OS的影响没有显着差异[风险比（HR）=0.998，95％置信区间（CI）：0.768-1.297]。AT和非AT（nAT）组之间的复发没有显着差异（HR=1.158，95％CI：0.764-1.755）。在亚组分析中，与在淋巴结阳性AmC中接受nAT的患者相比,接受AT的患者在OS方面表现出良好的结局(HR=0.627,95%CI:0.451~0.870).AT包括辅助化疗和放疗（HR=0.804，95％CI：0.563-1.149）和AT联合辅助化疗（HR=0.883，95％CI：0.642-1.214）均未显示对OS的显着影响。
结论：AT在AmC中对生存和复发的影响没有显示出显著的益处。此外，根据AT策略的有效性未显示生存率的提高.与nAT策略相比，在淋巴结阳性AmC中，AT在生存方面具有优势。在淋巴结受累阳性的AmC病例中，无论详细的策略如何，都可能需要AT。
方法：在PubMed中进行了全面的系统搜索，EMBASE,科克伦图书馆,和WebofScience数据库。包括比较AmC切除术后接受AT或未接受AT的患者的总生存期（OS）和无复发生存期（RFS）的研究。
结果：共分析了21项研究中的3971例患者。总体汇总数据显示AT对OS的影响没有显着差异[风险比（HR）=0.998，95％置信区间（CI）：0.768-1.297]。AT和非AT（nAT）组之间的复发没有显着差异（HR=1.158，95％CI：0.764-1.755）。在亚组分析中，与在淋巴结阳性AmC中接受nAT的患者相比,接受AT的患者在OS方面表现出良好的结局(HR=0.627,95%CI:0.451~0.870).AT包括辅助化疗和放疗（HR=0.804，95％CI：0.563-1.149）和AT联合辅助化疗（HR=0.883，95％CI：0.642-1.214）均未显示对OS的显着影响。
结论：AT在AmC中对生存和复发的影响没有显示出显著的益处。此外，根据AT策略的有效性未显示生存率的提高.与nAT策略相比，在淋巴结阳性AmC中，AT在生存方面具有优势。在淋巴结受累阳性的AmC病例中，无论详细的策略如何，都可能需要AT。
