title: Does lymph node ratio impact survival in resected periampullary malignancies?
abstract: BACKGROUND
  Lymph node ratio (LNR) has been associated with long-term survival in patients with pancreatic adenocarcinoma; however, this has not been demonstrated in other periampullary malignancies. The purpose of this study was to determine if LNR is associated with survival in other periampullary malignancies.
  
  
  METHODS
  A retrospective review of a prospective database of 522 pancreaticoduodenectomies (PDs) performed between 1988 and 2007 was undertaken. Clinicopathologic data were collected, and LNR was calculated. Patients with positive lymph node (LN) status were placed into the following groups: (1) LNR = 0; (2) LNR < or =0.2; (3) LNR < or =0.4; and (4) LNR >0.4.
  
  
  RESULTS
  Of the 364 malignancies identified, there were 219 (60%) pancreatic adenocarcinomas, 36 (10%) duodenal adenocarcinomas, 75 (21%) ampullary adenocarcinomas, and 35 (10%) cholangiocarcinomas. Positive LN status affected patient survival in all malignancies studied. Increasing LNR is associated with decreased survival in PA (P = .03) and AA (P = .04).
  
  
  CONCLUSIONS
  Positive LN status in all patients with periampullary malignancies is associated with worse survival rates than in those with no evidence of disease. LNR is inversely associated with survival rates in pancreatic and ampullary adenocarcinoma patients.
authors.affiliation: Department of Surgery, Division of Surgical Oncology, Loyola University Medical Center, Maywood, IL, USA.
authors.forename: Michael G
authors.initials: MG
authors.lastname: Hurtuk
authors.forename: Christopher
authors.initials: C
authors.lastname: Hughes
authors.forename: Margo
authors.initials: M
authors.lastname: Shoup
authors.forename: Gerard V
authors.initials: GV
authors.lastname: Aranha
mesh_terms: D000005:Abdomen; D000230:Adenocarcinoma / Q000401:mortality* / Q000473:pathology* / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014670:Ampulla of Vater; D018281:Cholangiocarcinoma / Q000401:mortality / Q000473:pathology / Q000601:surgery; D003138:Common Bile Duct Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery; D004067:Digestive System Neoplasms / Q000401:mortality* / Q000473:pathology* / Q000601:surgery; D004379:Duodenal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery; D008198:Lymph Nodes / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery; D016577:Pancreaticoduodenectomy; D012189:Retrospective Studies; D016019:Survival Analysis