The role of lymph nodes in predicting the prognosis of ampullary carcinoma after curative resection

Abstract

BackgroundLymph node involvement is one of the well-demonstrated prognostic factors in ampullary carcinoma. The aim of this study is to clarify the role of lymph nodes in predicting the survival outcome of ampullary carcinoma.MethodsA cohort of consecutive curative pancreaticoduodenectomies for ampullary carcinoma from 1999 to 2014 was retrospectively analyzed. The effect of node-associated variables, including lymph node status, positive lymph node number, total harvested lymph node (THLN) number, and lymph node ratio (LNR) was examined using univariate and multivariate analyses for survival outcome prediction.ResultsIn 194 evaluable patients, univariate analysis demonstrated that stage, cell differentiation, perineural invasion, and nodal status were significant conventional prognostic factors. Concerning the node-associated variables, positive nodal status, positive lymph node number ≥2, THLN number <14, and LNR ≥0.15 were significantly associated with poorer survival outcomes, with a 5-year survival rate of 20.3, 38.9, 25.4, and 18 %, respectively. By multivariate analysis, nodal status and THLN number were two independent predictors of survival. The most favorable 5-year survival rate was 84.4 % in patients with negative nodal involvement and THLN number ≥14, compared with the poorest 5-year survival rate of 16.1 % in those with positive nodal status and THLN number <14.ConclusionsTumor biology reflected by lymph node status is the most important independent prognostic factor; nevertheless, surgical radicality based on THLN number also plays a significant role in the survival outcome for patients with ampullary carcinoma after curative pancreaticoduodenectomy.

Prognostic Nomogram for Disease-Specific Survival in Patients with Non-metastatic Ampullary Carcinoma After Surgery

“…Although the 8th edition of the AJCC guidelines redefines the grouping of RNP and confirms its impact on prognosis,4 our study showed that LNR greatly impacts the nomogram, whereas the effect of the number of RNP is excluded from the Cox multivariate analysis. The result indicates that LNR plays an important role in prognosis assessment of ampullary carcinoma, a fact that has been demonstrated in other studies 16 – 18. LNR is incorporated into two variables—RNP and RNE; it not only considers the impact of RNP but also the impact of the total number of RNE on prognosis.…”

The retrospective analysis of periampullary region tumors

“…Ampulla kanserlerinde, literatürde tümör boyutu, tümörün derecesi, evre, lenf nodu metastazı varlığı prognoza etkili faktörler arasında belirtilmektedir [18]. Ampulla kanserlerinde lenf nodu metastazı izlenme yüzdesi %30-50 arasında değişmektedir [19,20]. Ampuller adenokarsinomların prognozu, PDA'ya oranla daha iyi olup, 5 yıllık yaşam süresi %30-60 olarak bildirilmektedir [20].…”

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

“…Recently, a retrospective study enrolled 111 patients who underwent Whipple surgery found that patients with ≥3 local LNMs had similar survival time as compared with the patients with distant LNM ( 1 ). Moreover, the total number of harvested lymph nodes is also a vital prognostic factor in AC ( 8 , 12 , 15 , 17 ). In view of this, some studies evaluated node staging for AC based on lymph node ratio (LNR) ( 7 , 9 , 11 , 18 , 23 ).…”