Serdar Balci1, Olca Basturk2, Burcu Saka3, Pelin Bagci1, Lauren M Postlewait4, Takuma Tajiri5, Kee-Taek Jang6, Nobuyuki Ohike7, Grace E Kim8, Alyssa Krasinskas1, Hyejeong Choi6, Juan M Sarmiento9, David A Kooby4, Bassel F El-Rayes10, Jessica H Knight11, Michael Goodman11, Gizem Akkas1, Michelle D Reid1, Shishir K Maithel4, Volkan Adsay12. 1. Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA, USA. 2. Department of Pathology, New York University, New York, NY, USA. 3. Department of Pathology, İstanbul Medipol University, İstanbul, Turkey. 4. Division of Surgical Oncology, Department of Surgery, Emory University, Atlanta, GA, USA. 5. Department of Pathology, Tokai University Hachiouji Hospital, Tokyo, Japan. 6. Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. 7. Department of Pathology, Showa University Fujigaoka Hospital, Tokyo, Japan. 8. Department of Pathology, University of California San Francisco, San Francisco, CA, USA. 9. Division of General and Gastrointstinal Surgery, Emory University, Atlanta, GA, USA. 10. Department of Oncology, Emory University, Atlanta, GA, USA. 11. Department of Epidemiology, Emory University, Atlanta, GA, USA. 12. Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA, USA. volkan.adsay@emory.edu.
Abstract
BACKGROUND: Current nodal staging (N-staging) of ampullary carcinoma in the TNM staging system distinguishes between node-negative (N0) and node-positive (N1) disease but does not consider the metastatic lymph node (LN) number. METHODS: Overall, 313 patients who underwent pancreatoduodenectomy for ampullary adenocarcinoma were categorized as N0, N1 (1-2 metastatic LNs), or N2 (≥3 metastatic LNs), as proposed by Kang et al. Clinicopathological features and overall survival (OS) of the three groups were compared. RESULTS: The median number of LNs examined was 11, and LN metastasis was present in 142 cases (45 %). When LN-positive cases were re-classified according to the proposed staging system, 82 were N1 (26 %) and 60 were N2 (19 %). There was a significant correlation between proposed N-stage and lymphovascular invasion, perineural invasion, increased tumor size (each p < 0.001), and surgical margin positivity (p = 0.001). The median OS in LN-negative cases was significantly longer than that in LN-positive cases (107.5 vs. 32 months; p < 0.001). Patients with N1 and N2 disease had median survivals of 40 and 24.5 months, respectively (p < 0.0001). In addition, 1-, 3-, and 5-year survivals were 88, 76, 62 %, respectively, for N0; 90, 55, 31.5 %, respectively, for N1; and 68, 34, 30 %, respectively for N2 (p < 0.001). Even with multivariate modeling, the association between higher proposed N stage and shorter survival persisted (hazard ratio 1.6 for N1 and 1.9 for N2; p = 0.018). CONCLUSIONS: Classification of nodal status in ampullary carcinomas based on the number of metastatic LNs has a significant prognostic value. A revised N-staging classification system should be incorporated into the TNM staging of ampullary cancers.
BACKGROUND: Current nodal staging (N-staging) of ampullary carcinoma in the TNM staging system distinguishes between node-negative (N0) and node-positive (N1) disease but does not consider the metastatic lymph node (LN) number. METHODS: Overall, 313 patients who underwent pancreatoduodenectomy for ampullary adenocarcinoma were categorized as N0, N1 (1-2 metastatic LNs), or N2 (≥3 metastatic LNs), as proposed by Kang et al. Clinicopathological features and overall survival (OS) of the three groups were compared. RESULTS: The median number of LNs examined was 11, and LN metastasis was present in 142 cases (45 %). When LN-positive cases were re-classified according to the proposed staging system, 82 were N1 (26 %) and 60 were N2 (19 %). There was a significant correlation between proposed N-stage and lymphovascular invasion, perineural invasion, increased tumor size (each p < 0.001), and surgical margin positivity (p = 0.001). The median OS in LN-negative cases was significantly longer than that in LN-positive cases (107.5 vs. 32 months; p < 0.001). Patients with N1 and N2 disease had median survivals of 40 and 24.5 months, respectively (p < 0.0001). In addition, 1-, 3-, and 5-year survivals were 88, 76, 62 %, respectively, for N0; 90, 55, 31.5 %, respectively, for N1; and 68, 34, 30 %, respectively for N2 (p < 0.001). Even with multivariate modeling, the association between higher proposed N stage and shorter survival persisted (hazard ratio 1.6 for N1 and 1.9 for N2; p = 0.018). CONCLUSIONS: Classification of nodal status in ampullary carcinomas based on the number of metastatic LNs has a significant prognostic value. A revised N-staging classification system should be incorporated into the TNM staging of ampullary cancers.
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: Taylor S Riall; John L Cameron; Keith D Lillemoe; Jordan M Winter; Kurtis A Campbell; Ralph H Hruban; David Chang; Charles J Yeo Journal: Surgery Date: 2006-08-28 Impact factor: 3.982
Authors: Ibrahim Nassour; Alana Christie; Michael A Choti; John C Mansour; Rebecca M Minter; Patricio M Polanco; Mathew M Augustine; Matthew R Porembka; Xian-Jin Xie; Sam C Wang Journal: J Gastrointest Surg Date: 2018-03-15 Impact factor: 3.452
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