Keita Tashiro1, Naomi Kuroki2, Takahiro Einama1, Toshimitsu Iwasaki1, Yoichi Miyata1, Suefumi Aosasa1,3, Yosuke Inoue2, Yu Takahashi2, Sho Ogata4, Hideki Ueno1, Kazuo Hase1, Junji Yamamoto1,5, Yoji Kishi1. 1. Department of Surgery, National Defense Medical College Hospital, Tokorozawa, Saitama, Japan. 2. Department of Gastrointestinal Surgery, Cancer Institute Hospital, Koto, Tokyo, Japan. 3. Department of Surgery, Shin-Kuki General Hospital, Kuki, Saitama, Japan. 4. Department of Pathology and Laboratory Medicine, National Defense Medical College, Tokorozawa, Saitama, Japan. 5. Department of Gastrointestinal Surgery, Ibaraki Prefectural Central Hospital, Kasama, Ibaraki, Japan.
Abstract
BACKGROUND: The TNM (Tumor, Node, Metastasis) classification of the 8th Union for International Cancer Control and the 6th Japanese classification of biliary tract cancer were made on the premise that the prognostic effect of each regional lymph node station is similar. However, some studies have reported different effects of lymph node metastasis location on post-resection prognosis. This study aimed to investigate outcome following radical resection of ampullary carcinoma according to station of lymph node metastasis. METHODS: Patients who underwent surgical resection for ampullary carcinoma between January 2007 and December 2017 at two separate Japanese institutions were included. Regional lymph nodes were subclassified as follows: Pancreatoduodenal lymph nodes (PD) and others (OT). RESULTS: Of the 101 patients analyzed, 34 had regional lymph node metastasis. OT metastasis was found in eight patients. Significant differences were found in relapse-free survival (RFS) and overall survival (OS) between the three study groups (no nodal metastasis, only PD metastasis and OT metastasis) (P < 0.001 for both). OT metastasis was an independent prognostic factor in the multivariate analysis for RFS (hazard ratio (HR) 17.14; 95% confidence interval (CI), 6.33-43.93) and OS (HR 11.06; 95% CI, 3.7-32.99). CONCLUSION: The poor prognosis of ampullary carcinoma patients with OT metastasis suggests that regional lymph nodes shouldn't be categorized equally into one group. This article is protected by copyright. All rights reserved.
BACKGROUND: The TNM (Tumor, Node, Metastasis) classification of the 8th Union for International Cancer Control and the 6th Japanese classification of biliary tract cancer were made on the premise that the prognostic effect of each regional lymph node station is similar. However, some studies have reported different effects of lymph node metastasis location on post-resection prognosis. This study aimed to investigate outcome following radical resection of ampullary carcinoma according to station of lymph node metastasis. METHODS:Patients who underwent surgical resection for ampullary carcinoma between January 2007 and December 2017 at two separate Japanese institutions were included. Regional lymph nodes were subclassified as follows: Pancreatoduodenal lymph nodes (PD) and others (OT). RESULTS: Of the 101 patients analyzed, 34 had regional lymph node metastasis. OT metastasis was found in eight patients. Significant differences were found in relapse-free survival (RFS) and overall survival (OS) between the three study groups (no nodal metastasis, only PD metastasis and OT metastasis) (P < 0.001 for both). OT metastasis was an independent prognostic factor in the multivariate analysis for RFS (hazard ratio (HR) 17.14; 95% confidence interval (CI), 6.33-43.93) and OS (HR 11.06; 95% CI, 3.7-32.99). CONCLUSION: The poor prognosis of ampullary carcinomapatients with OT metastasis suggests that regional lymph nodes shouldn't be categorized equally into one group. This article is protected by copyright. All rights reserved.