Development and Validation of a New Lymph Node Ratio-Based Staging System for Ampullary Carcinoma After Curative Pancreaticoduodenectomy

Abstract

BackgroundLymph node metastasis (LNM) is closely associated with the prognosis of ampullary carcinoma (AC). The purpose of this study is to explore the relationship between lymph node ratio (LNR) and the prognosis of patients with AC after curative pancreaticoduodenectomy and to establish a new LNR-based staging system.MethodsAC patients in the Cancer Hospital, Chinese Academy of Medical Sciences, between 1998 and 2020 were retrospectively reviewed as the training cohort; and AC patients in the Surveillance, Epidemiology, and End Results (SEER) database between 2010 and 2018 were obtained as the validation cohort. Within the training group, Kaplan–Meier survival analyses and Cox proportional hazards regression were conducted to assess the prognostic value of LNR and establish a new LNR-based staging system. Then, the new staging system was compared with the 8th American Joint Committee on Cancer (AJCC) TNM staging system in both the training and validation cohorts.ResultsA total of 264 patients in the training cohort and 199 patients in the validation cohort were enrolled. Significant overall survival (OS) difference was observed between LNR-low stage and LNR-high stage in both training (p = 0.001) and validation cohorts (p < 0.001). Then a new LNR-based staging system was developed. Under the new system, the number of patients in the training cohort and validation cohort of stage I, stage II, and stage III was 30 (11%) vs. 18 (9%), 190 (72%) vs. 96 (48%), and 44 (17%) vs. 85 (43%), respectively. The new staging system classified patients with respect to survival better than did the 8th AJCC TNM staging system.ConclusionsThe new LNR-based staging system had better discriminability for predicting survival in AC patients after curative pancreaticoduodenectomy. More data are needed for further validation.

Machine learning models for predicting survival in patients with ampullary adenocarcinoma

“… 6 , 7 Patients with AAC tend to present typical symptoms of biliary obstruction at relatively early stages, but these symptoms are mostly non-specific and are therefore often detected incidentally during examinations. 8 , 9 Although the early detection of symptoms helps to improve the resection rates in radical surgery, which is the standard treatment for AAC, high risks of recurrence, and postoperative mortality are major concerns. 10 , 11 Different centers have reported a wide range of 5-year overall survival (OS) rates after AAC resection of 32%–69.1%, with a median survival time of 28–70 months, while the 10-year OS rate ranged from 26% to 48%.…”

“…Previous research has used various types of prediction models to assess the short-term survival rates of AAC, including Kaplan–Meier survival analysis, logistic regression, and the Cox proportional hazards (CoxPH) model. 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 Kaplan–Meier survival analysis is the most commonly method used to investigate the prognostic factors for AAC, which does not allow adjustments for confounders and has a restrictive assumption of non-informative censoring. 24 , 25 Logistic regression models aim to estimate the relationship between potential factors and survival outcomes as well as adjust for confounders.…”

“…Despite its rarity, the occurrence of AAC has increased worldwide over the past few decades 6,7 . Patients with AAC tend to present typical symptoms of biliary obstruction at relatively early stages, but these symptoms are mostly nonspecific and are therefore often detected incidentally during examinations 8,9 . Although early detection of symptoms helps to improve resection rates in radical surgery, which is the standard treatment for AAC, high risks of recurrence and postoperative mortality are major concerns 10,11 .…”

“…Previous research has used various types of prediction models to assess the shortterm survival rates of AAC, including Kaplan-Meier survival analysis, logistic regression, and the Cox proportional-hazards (CoxPH) model [5][6][7][8][9][10][11][12][13][16][17][18][19][20][21][22][23] . Kaplan-Meier J o u r n a l P r e -p r o o f survival analysis is the most commonly method used to investigate the prognostic factors for AAC, which does not allow adjustments for confounders and has a restrictive assumption of noninformative censoring 24,25 .…”

Impact of Diabetes on Short-Term and Long-Term Outcomes of Ampullary Adenocarcinoma Patients after Curative Pancreatoduodenectomy

“…To date, surgical resection remains the potential curative strategy in AC patients [ 4 ]. Generally, the prognosis of AC is poor, with a 5-year survival rate of less than 45% in the resected patients [ 5 ].…”