title: Prognostic impact of histological blood vessel invasion in patients with ampullary adenocarcinoma.
abstract: OBJECTIVE
  Ampullary adenocarcinoma (AmpCA) has a greater overall survival (OS) rate than other periampullary cancers such as pancreatic cancer or bile duct cancer. Nevertheless, the OS of AmpCA is still poor. In the present study we evaluated the clinicopathologic features of AmpCA with respect to its impact on OS.
  
  
  METHODS
  Records of 28 patients with AmpCA undergoing pancreaticoduodenectomy from 1995 to 2009 in Kyoto Prefectural University of Medicine were reviewed retrospectively. The mean age was 65.6 and mean +/- S.D. tumor size was 2.08 +/- 1.13 cm. Of the 28 patients, nine (32%) were > or = T3 tumors and nine (32%) were pN1 stage. There were seven (25%) cases of pancreatic invasion (Panc-invasion) and 15 (54%) cases of duodenal invasion (Du-invasion). Further, 14 (50%) cases involved lymphatic vessel invasion (ly+) and five (18%) cases involved histological blood vessel invasion (v+). Eleven (39%) patients experienced recurrences, of which eight were liver metastases. The median OS was 37 months (range 0.6-139.6 months) and the five-year survival rate was 56.4%. The clinicopathologic features and prognoses of these patients were analyzed and the prognostic factors determined.
  
  
  RESULTS
  On log-rank testing, Du-invasion (p = 0.029), ly+ (p = 0.022), and v+ (p < 0.001) were significantly associated with worse survival. According to multivariate Cox's hazard analysis using these three factors by Backward Elimination of Stepwise method, blood vessel invasion was the only significant prognostic indicator for survival (p = 0.046; Hazard ratio, 4.40).
  
  
  CONCLUSIONS
  Blood vessel invasion was an independent prognostic indicator, while prevention of liver metastases was important for longer survival.
authors: Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto 6028566, Japan.
authors: Tsutomu
authors: T
authors: Kawaguchi
authors: Toshiya
authors: T
authors: Ochiai
authors: Hisashi
authors: H
authors: Ikoma
authors: Koji
authors: K
authors: Inoue
authors: Ryo
authors: R
authors: Morimura
authors: Yasutoshi
authors: Y
authors: Murayama
authors: Shuhei
authors: S
authors: Komatsu
authors: Atsushi
authors: A
authors: Shiozaki
authors: Yoshiaki
authors: Y
authors: Kuriu
authors: Masayoshi
authors: M
authors: Nakanishi
authors: Daisuke
authors: D
authors: Ichikawa
authors: Kazuma
authors: K
authors: Okamoto
authors: Hitoshi
authors: H
authors: Fujiwara
authors: Yukihito
authors: Y
authors: Kokuba
authors: Teruhisa
authors: T
authors: Sonoyama
authors: Eigo
authors: E
authors: Otsuji
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology* / Q000601:surgery*; D000328:Adult; D000368:Aged; D014670:Ampulla of Vater / Q000473:pathology*; D003138:Common Bile Duct Neoplasms / Q000473:pathology* / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D016577:Pancreaticoduodenectomy; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D019043:Vascular Neoplasms / Q000473:pathology*