Prognostic Significance of Nodal Ratio in Patients Undergoing Adjuvant Chemoradiotherapy After Curative Resection for Ampullary Cancer

Kim, Kyubo; Chie, Eui Kyu; Jang, Jin Young; Kim, Sun Whe; Han, Sae Won; Oh, Do Youn; Im, Seock Ah; Kim, Tae You; Bang, Yung Jue; Ha, Sung Whan

doi:10.1097/coc.0000000000000075

Cited by 7 publications

(5 citation statements)

References 19 publications

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“…Considering that the prognostic cut-off value for ampullary cancer ranges from 0.1 to 0.2, 15,16,19,24 the calculated cut-off value of 0.07 is consistent with previous reports. Based on the results of the ASCOT trial, 10 S-1 would be a standard treatment for adjuvant chemotherapy after curative surgery; however, in cases with an LNR ≥ 0.07, the introduction of more effective regimens would be required to improve the prognosis.…”

Section: Discussionsupporting

confidence: 90%

“…Several prognostic factors have been reported in ampullary cancer after surgical resection, including age, lymph node metastasis, number of lymph node metastases, LNR, pancreatic and duodenal invasion, stage, tumor size, gross appearance, perineural invasion, histological type, and lymphovascular invasion. [18][19][20][21][22][23][24] This study's multivariate analysis for OS identi ed sex and lymph node metastasis as independent prognostic factors (Table 2).…”

Section: Discussionmentioning

confidence: 99%

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The clinical significance of the lymph node ratio as a recurrence indicator in ampullary cancer after curative pancreaticoduodenectomy

Hasegawa,

Wada,

Kubo

et al. 2024

Preprint

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Background The clinical significance of the lymph node ratio (LNR), the number of metastatic lymph nodes per dissected lymph node, has not been sufficiently clarified in ampullary cancer. Methods Among patients diagnosed histopathologically with ampullary cancer between 1980 and 2018, the study included 106 who underwent pathological radical resection by pancreaticoduodenectomy. The relationships between the LNR and metastatic lymph node sites and prognosis were examined. Results Multivariate analysis revealed that sex and lymph node metastasis were independent prognostic factors. In the 46 patients (43%) with metastatic lymph nodes, the LNR in the recurrence group was significantly higher than that in the non-recurrence group (0.15 ± 0.11 vs. 0.089 ± 0.071, p = 0.025). The receiver operating characteristic curve demonstrated that the LNR cut-off value, 0.07 (area under the curve = 0.70, sensitivity 81%, specificity 56%), was a significant indicator for recurrence (22% vs. 61%, p = 0.016) and prognosis (5-year survival: 48% vs. 83%, p = 0.028). Among the metastatic lymph node sites in the 46 positive cases, lymph node metastases developed from the peripancreatic head region (80%, 37/46) to the superior mesenteric artery (33%, 15/46) and para-aortic (11%, 5/46) regions. Conclusion Lymph node metastasis is an independent prognostic factor, and the LNR is a significant indicator for recurrence and prognosis in patients with ampullary cancer.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

The clinical significance of the lymph node ratio as a recurrence indicator in ampullary cancer after curative pancreaticoduodenectomy

Hasegawa,

Wada,

Kubo

et al. 2024

Preprint

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“…In previous studies, several predictors of LNM in resected AVC have been described including number of retrieved LNs, ratio of positive LNs/retrieved LNs, number of metastatic LNs (based on UICC N stage classi cation), and location of regional LNs (pancreatic head or except for pancreas head) [5,6,[18][19][20]. Matui et al reported that regional LNM, except to the pancreatic head region, was associated with poor prognosis, comparable to that of patients with M1-stage [21].…”

Section: Discussionmentioning

confidence: 99%

WITHDRAWN: Importance of lymph node metastasis to the pancreatic head region in patients with ampulla of Vater carcinoma

Tabuchi

Kimura

Sui

et al. 2022

Preprint

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Background: We analyzed clinicopathologic variables and postoperative outcomes in patients with ampulla of Vater carcinoma (AVC) to identify key predictors of post-resection prognosis.Methods: Fifty-five patients who underwent pancreaticoduodenectomy for AVC with curative intent between 2005 and 2020 were included in this study. A retrospective review of the clinical records of patients who underwent surgical exploration for AVC was performed using univariate and multivariate analyses. Clinical and pathological factors that influenced patient survival were analyzed. Results: One-, 3-, and 5-year overall survival rates after surgery were 97.4%, 71.8%, and 63.0%, respectively. A total of 21 patients developed recurrent disease after curative resection for AVC. The most frequently observed sites of recurrence were lymph nodes in 11 patients (52%), followed by the liver in 8 (38%), lung in 6 (29%), local in 3 (14%), and peritoneal dissemination in 3 (14%). Estimated 3- and 5-year recurrence free survival rates for the entire cohort were 62.8% and 57.2%, respectively. On multivariate analysis, only the presence of lymph node metastasis extending to the pancreatic head region (hazard ratio = 5.374; 95% confidence interval: 1.279–22.58; P = 0.022) predicted inferior relapse-free survival. A significant correlation between postoperative recurrence and pathological lymph node metastasis was observed. Conclusions: Lymph node metastasis, especially that which extends to the pancreatic head region, was clearly identified as a prognostic indicator of reduced relapse-free survival in patients who have undergone curative surgical treatment for AVC.

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“…LNR has been confirmed as a prognostic factor of AC patients, but no uniform cutoff threshold for LNR has been established. Kim et al retrospectively analyzed 71 patients with AC who underwent adjuvant chemotherapy after radical resection and found that LNR > 0.15 was an independent risk factor for OS (10). In an analysis of 212 AC patients who received radical surgery in Taiwan, LNR > 0.056 indicated poor DFS and OS (11).…”

Section: Discussionmentioning

confidence: 99%

“…It has been reported the rate of lymph node metastasis (LNM) ranges from 20% to 50% (1). Despite many clinicopathologic characters are associated with prognosis for AC patients, LNM is still one of the most crucial risk factors (1,(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25).…”

Section: Introductionmentioning

confidence: 99%

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

Zhang

Sun

et al. 2022

Front. Oncol.

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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.

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Prognostic Significance of Nodal Ratio in Patients Undergoing Adjuvant Chemoradiotherapy After Curative Resection for Ampullary Cancer

Abstract: Adjuvant chemoradiotherapy after curative resection can achieve a long-term survival rate in patients with ampullary cancer. Nodal ratio and histologic differentiation are independent prognostic factors for these patients.

Cited by 7 publications

References 19 publications

The clinical significance of the lymph node ratio as a recurrence indicator in ampullary cancer after curative pancreaticoduodenectomy

The clinical significance of the lymph node ratio as a recurrence indicator in ampullary cancer after curative pancreaticoduodenectomy

WITHDRAWN: Importance of lymph node metastasis to the pancreatic head region in patients with ampulla of Vater carcinoma

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

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