title: Glasgow prognostic score predicts therapeutic outcome after pancreaticoduodenectomy for carcinoma of the ampulla of vater.
abstract: BACKGROUND
  Systemic inflammation, as evidenced by the Glasgow prognostic score (GPS), predicts cancer-specific survival in various types of cancer. The aim of this study was to evaluate the significance of GPS on the therapeutic outcome after pancreaticoduodenectomy for carcinoma of the ampulla of Vater.
  
  
  METHODS
  The subjects of this study were 30 patients who underwent elective pancreaticoduodenectomy for carcinoma of the ampulla of Vater. For the assessment of systemic inflammatory response using the GPS, patients were classified into three groups: patients with normal albumin (≥ 3.5 g/dl) and normal C-reactive protein (CRP) (≤ 1.0 mg/dl) as GPS 0 (n=23), those with low albumin (<3.5 g/dl) or elevated CRP (>1.0 mg/dl) as GPS 1 (n=5), and those with low albumin (<3.5 g/dl) and elevated CRP (>1.0 mg/dl) as GPS 2 (n=2). We retrospectively investigated the relationship between patients' characteristics, including GPS, and disease-free survival, as well as overall survival.
  
  
  RESULTS
  For disease-free survival, advanced tumor stage (p=0.0401), advanced lymph node metastasis (p<0.0001), and preoperative biliary drainage (p=0.0157) in univariate analysis, and advanced lymph node metastasis (p=0.0271) in multivariate analysis were significant and independent predictors of cancer recurrence. For overall survival, in both univariate and multivariate analyses, advanced lymph node metastasis (p=0.0006 and p=0.0411, respectively) and GPS 1 or 2 (p=0.0034 and p=0.0484, respectively) were significant and independent predictors of poor patient outcome.
  
  
  CONCLUSIONS
  The GPS in patients with carcinoma of the ampulla of Vater is an independent prognostic predictor after elective pancreaticoduodenectomy.
authors.affiliation: Department of Surgery, School of Medicine, Jikei University, Minato-ku, Tokyo, Japan. hs0817@jikei.ac.jp
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Shiba
authors.forename: Takeyuki
authors.initials: T
authors.lastname: Misawa
authors.forename: Yuki
authors.initials: Y
authors.lastname: Fujiwara
authors.forename: Yasuro
authors.initials: Y
authors.lastname: Futagawa
authors.forename: Kenei
authors.initials: K
authors.lastname: Furukawa
authors.forename: Koichiro
authors.initials: K
authors.lastname: Haruki
authors.forename: Ryota
authors.initials: R
authors.lastname: Iwase
authors.forename: Shigeki
authors.initials: S
authors.lastname: Wakiyama
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Ishida
authors.forename: Katsuhiko
authors.initials: K
authors.lastname: Yanaga
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014670:Ampulla of Vater; D003138:Common Bile Duct Neoplasms / Q000401:mortality* / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007249:Inflammation; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D016577:Pancreaticoduodenectomy; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome
keywords: Glasgow prognostic score; carcinoma of the ampulla of Vater; pancreaticoduodenectomy; prognosis