Lymph node involvement in ampullary cancer: the importance of the number, ratio, and location of metastatic nodes.
OBJECTIVE
Lymph node involvement significantly affects survival of cancer patients. The aim of this study was to evaluate the importance of the number, ratio, and location of metastatic lymph nodes in ampullary cancers.


METHODS
Medical records of 111 patients who underwent curative pancreaticoduodenectomy for ampullary carcinomas were reviewed.


RESULTS
Metastatic lymph nodes were found in 52 (47%) patients and the median number of involved nodes was 3 (95% confidence interval (CI) 3-4; range 1-17). In the univariate analysis, gender, type of pancreaticoduodenectomy, depth of tumor invasion, perineural invasion, presence of metastatic nodes, their number, and ratio of metastatic nodes significantly correlated with patient survival. However, the location of metastatic nodes did not influence survival among patients with nodal involvement. Only four or more metastatic nodes (relative risk 7.35, 95% CI 3.34-16.17) and tumor invasion of peripancreatic soft tissues (relative risk 5.00, 95% CI 1.20-20.92) were the independent prognostic factors in the multivariate analysis.


CONCLUSIONS
The number of metastatic nodes significantly affected patient survival. Although the location and ratio of metastatic nodes were not independent prognostic factors, these variables should be further evaluated with large-scale population data sets.
Sierzega
Marek
M
1st Department of Surgery, Jagiellonian University Medical College, Krakow, Poland. sierzega@autocom.pl
Nowak
Krystyna
K
Kulig
Jan
J
Matyja
Andrzej
A
Nowak
Wojciech
W
Popiela
Tadeusz
T
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014670:Ampulla of Vater / Q000473:pathology*; D003138:Common Bile Duct Neoplasms / Q000401:mortality / Q000473:pathology*; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D011379:Prognosis