title: Number of positive lymph nodes independently affects long-term survival after resection in patients with ampullary carcinoma.
abstract: OBJECTIVE
  The nodal status is an established prognostic factor in ampullary carcinoma. The aim of this study was to compare the prognostic power of the anatomic location of positive nodes with that of the number of positive nodes.
  
  
  METHODS
  Of 73 consecutive patients treated for ampullary carcinoma, 62 underwent pancreaticoduodenectomy with regional lymphadenectomy. A survival analysis of these 62 patients by nodal status was conducted retrospectively. A total of 1942 lymph nodes taken from the patients were examined histologically for metastasis. The location of positive regional nodes was classified into 4 categories, according to the Japanese staging system. The number of positive regional nodes was recorded for each patient. The median follow-up period was 124 months.
  
  
  RESULTS
  Nodal disease was found in 31 patients, of whom 23 had 1-3 positive regional nodes and 8 had >or=4 positive regional nodes. Univariate analysis revealed that both the location (p<0.0001) and the number (p<0.0001) of positive nodes were significant prognostic factors. Multivariate analysis revealed that the number of positive nodes was an independent prognostic factor (p=0.007), while the location failed to remain as an independent variable. The median survival time was 59 months with a 5-year survival rate of 48% in patients with 1-3 positive nodes, whereas all patients with >or=4 positive nodes died of the disease within 29 months of resection (p=0.0001).
  
  
  CONCLUSIONS
  The number, not the location, of positive regional lymph nodes independently affects long-term survival after resection in patients with ampullary carcinoma.
authors.affiliation: Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Niigata City 951-8510, Japan.
authors.forename: J
authors.initials: J
authors.lastname: Sakata
authors.forename: Y
authors.initials: Y
authors.lastname: Shirai
authors.forename: T
authors.initials: T
authors.lastname: Wakai
authors.forename: N
authors.initials: N
authors.lastname: Yokoyama
authors.forename: E
authors.initials: E
authors.lastname: Sakata
authors.forename: K
authors.initials: K
authors.lastname: Akazawa
authors.forename: K
authors.initials: K
authors.lastname: Hatakeyama
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014670:Ampulla of Vater / Q000473:pathology / Q000601:surgery*; D003138:Common Bile Duct Neoplasms / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D016577:Pancreaticoduodenectomy; D011379:Prognosis; D016016:Proportional Hazards Models; D015996:Survival Rate; D016896:Treatment Outcome