Enhanced survival in resectable duodenal adenocarcinoma with adjuvant chemotherapy: evidence from a retrospective study

Background Duodenal adenocarcinoma (DA) is a rare malignancy, and the effectiveness of adjuvant chemotherapy on survival after surgical intervention remains ambiguous. This study investigates the impact of adjuvant chemotherapy on overall survival (OS) and recurrence-free survival (RFS) in patients with resectable DA. Materials and methods Data from ninety-eight stage I-III DA patients who underwent surgical resection between January 1998 and December 2021 at two Chinese institutions were analyzed retrospectively. Survival outcomes were assessed using the Kaplan-Meier method, and multivariable Cox proportional hazards models identified significant prognostic factors. Results Of the 98 patients, 45 received adjuvant chemotherapy and 53 did not. The median follow-up was 49 months. Patients who had adjuvant chemotherapy showed a longer median OS (52.9 vs. 25.1 months, p=0.003) and RFS (38.2 vs. 9.9 months, p<0.001) than those without. N stage was associated with reduced OS and RFS. Multivariate analysis identified adjuvant chemotherapy, N stage, and CA199 as independent predictors for RFS and OS. For patients with initial CA199 ≥ 27U/mL, adjuvant chemotherapy appeared to be associated with improvements in RFS and OS, alongside suggestive reductions in recurrence and mortality risks. Conclusion Adjuvant chemotherapy correlates with an extended median OS and RFS, as well as a reduced risk of recurrence and mortality in patients who have undergone surgical resection for DA. Specifically, patients with DA who are in the N1 or N2 stage, or those with a CA199≥27U/mL at their initial diagnosis, may show potential clinical benefits from adjuvant chemotherapy as a preliminary exploratory finding.