Jianguo Zhou1, Qian Zhang2, Peng Li1, Yi Shan1, Dongbing Zhao1, Jianqiang Cai1. 1. Department of Abdominal Surgery, Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100021, China; 2. Department of General Surgery, Aerospace Central Hospital, Beijing 100049, China.
Abstract
OBJECTIVES: To explore the prognostic relevance of the number and ratio of metastatic lymph nodes in resected Carcinoma of the ampulla of Vater (CAV). METHODS: The clinical data of 155 patients who underwent pancreaticoduodenectomy (PD) for cancer of the ampulla of Vater between January 1990 and December 2010 were retrospectively analyzed. Kaplan-Meier method was used in survival analysis and Log rank method in comparison. Multivariate analysis was performed using Cox proportional hazards model. RESULTS: Among these 155 patients, the in-hospital mortality rate was 4.5%, lymph node positive disease was 21.3%, and the 5-year survival rate was 51.6%. Patients with a lymph node ratio (LNR) >20% were more likely to have tumor differentiation, depth of duodenal involvement, depth of pancreatic invasion, T-stage and TNM-Stage. The number of the metastatic lymph nodes is important prognostic factors of the CAV. Univariate analysis showed that the factors associated with the prognosis included tumor size (P=0.036), tumor differentiation (P=0.019), LNR (P=0.032), number of metastatic lymph nodes (P=0.024), lymph node metastasis (P=0.03), depth of pancreatic invasion (P=0.001), T-stage (P=0.002), TNM stage (P=0.001), elevated CA 19-9 (P=0.000), and jaundice (P=0.021). Multivariate analysis showed that the factors associated with the prognosis were the number of metastatic lymph nodes (P=0.032; RR: 1.283; 95% CI: 1.022-1.611), tumor size (P=0.043; RR: 1.736; 95% CI: 1.017-2.963), and elevated CA 19-9 (P=0.003; RR: 3.247; 95% CI: 1.504-7.010). CONCLUSIONS: LNR is a useful factor for predicting the prognosis of the radical treatment for CAV, whereas the number of metastatic lymph nodes is the most important factor. Further research on the locations, number, and LNR will be clinically meaningful to improve survival in patients with CAV.
OBJECTIVES: To explore the prognostic relevance of the number and ratio of metastatic lymph nodes in resected Carcinoma of the ampulla of Vater (CAV). METHODS: The clinical data of 155 patients who underwent pancreaticoduodenectomy (PD) for cancer of the ampulla of Vater between January 1990 and December 2010 were retrospectively analyzed. Kaplan-Meier method was used in survival analysis and Log rank method in comparison. Multivariate analysis was performed using Cox proportional hazards model. RESULTS: Among these 155 patients, the in-hospital mortality rate was 4.5%, lymph node positive disease was 21.3%, and the 5-year survival rate was 51.6%. Patients with a lymph node ratio (LNR) >20% were more likely to have tumor differentiation, depth of duodenal involvement, depth of pancreatic invasion, T-stage and TNM-Stage. The number of the metastatic lymph nodes is important prognostic factors of the CAV. Univariate analysis showed that the factors associated with the prognosis included tumor size (P=0.036), tumor differentiation (P=0.019), LNR (P=0.032), number of metastatic lymph nodes (P=0.024), lymph node metastasis (P=0.03), depth of pancreatic invasion (P=0.001), T-stage (P=0.002), TNM stage (P=0.001), elevated CA 19-9 (P=0.000), and jaundice (P=0.021). Multivariate analysis showed that the factors associated with the prognosis were the number of metastatic lymph nodes (P=0.032; RR: 1.283; 95% CI: 1.022-1.611), tumor size (P=0.043; RR: 1.736; 95% CI: 1.017-2.963), and elevated CA 19-9 (P=0.003; RR: 3.247; 95% CI: 1.504-7.010). CONCLUSIONS: LNR is a useful factor for predicting the prognosis of the radical treatment for CAV, whereas the number of metastatic lymph nodes is the most important factor. Further research on the locations, number, and LNR will be clinically meaningful to improve survival in patients with CAV.
Entities:
Keywords:
Ampulla of vater; carcinoma; lymph nodes; metastasis; prognosis
Authors: Jae Hoon Lee; Kyeong Geun Lee; Tae Kyung Ha; Young Jin Jun; Seung Sam Paik; Hwon Kyum Park; Kwang Soo Lee Journal: Am Surg Date: 2011-03 Impact factor: 0.688
Authors: Ewa Pomianowska; Arne Westgaard; Øystein Mathisen; Ole Petter F Clausen; Ivar P Gladhaug Journal: Ann Surg Oncol Date: 2012-08-15 Impact factor: 5.344
Authors: S M M de Castro; N T van Heek; K F D Kuhlmann; O R C Busch; G J A Offerhaus; T M van Gulik; H Obertop; D J Gouma Journal: Surgery Date: 2004-11 Impact factor: 3.982
Authors: Marek Sierzega; Krystyna Nowak; Jan Kulig; Andrzej Matyja; Wojciech Nowak; Tadeusz Popiela Journal: J Surg Oncol Date: 2009-07-01 Impact factor: 3.454
Authors: Jessica B O'Connell; Melinda A Maggard; Jesse Manunga; James S Tomlinson; Howard A Reber; Clifford Y Ko; O Joe Hines Journal: Ann Surg Oncol Date: 2008-03-28 Impact factor: 5.344
Authors: C A M Sommerville; P Limongelli; M Pai; R Ahmad; G Stamp; N A Habib; R C N Williamson; L R Jiao Journal: J Surg Oncol Date: 2009-12-15 Impact factor: 3.454
Authors: Ioannis Hatzaras; Nathaniel George; Peter Muscarella; W Scott Melvin; E Christopher Ellison; Mark Bloomston Journal: Ann Surg Oncol Date: 2010-01-28 Impact factor: 5.344
Authors: Serdar Balci; Olca Basturk; Burcu Saka; Pelin Bagci; Lauren M Postlewait; Takuma Tajiri; Kee-Taek Jang; Nobuyuki Ohike; Grace E Kim; Alyssa Krasinskas; Hyejeong Choi; Juan M Sarmiento; David A Kooby; Bassel F El-Rayes; Jessica H Knight; Michael Goodman; Gizem Akkas; Michelle D Reid; Shishir K Maithel; Volkan Adsay Journal: Ann Surg Oncol Date: 2015-03-18 Impact factor: 5.344
Authors: Jeong Woo Lee; Sae Byeol Choi; Tae Wan Lim; Wan Joon Kim; Pyoungjae Park; Wan Bae Kim Journal: Ann Hepatobiliary Pancreat Surg Date: 2021-02-28