title: The Association between Survival and the Pathologic Features of Periampullary Tumors Varies over Time.
abstract: Introduction. Several histopathologic features of periampullary tumors have been shown to be correlated with prognosis. We evaluated their association with mortality at multiple time points. Methods. A retrospective chart review identified 207 patients with periampullary adenocarcinomas who underwent pancreaticoduodenectomy between January 1, 2001 and December 31, 2009. Clinicopathologic features were assessed, and the data were analyzed using univariate and multivariate methods. Results. In univariate analysis, perineural invasion had a strong association with 1-year mortality (OR 3.03, CI 1.42-6.47), and one lymph node (LN) increase in the LN ratio (LNR) equated with a 5-fold increase in mortality. In contrast, LN status (OR 6.42, CI 3.32-12.41) and perineural invasion (OR 5.44, CI 2.81-10.52) had the strongest associations with mortality at 3 years. Using Cox proportional hazards, perineural invasion (HR 2.61, CI 1.77-3.85) and LN status (HR 2.69, CI 1.84-3.95) had robust associations with overall mortality. Recursive partitioning analysis identified LNR as the most important risk factor for mortality at 1 and 3 years. Conclusions. Overall mortality was closely related to the LNR within the first year, while longer follow-up periods demonstrated a stronger association with perineural invasion and overall LN status. Therefore, the current staging for periampullary tumors may need to be updated to include the LNR.
authors.affiliation: Department of Surgery, Loyola University Health Systems, 2160 S. First Avenue, Maywood, IL 60153, USA.
authors.forename: Jennifer K
authors.initials: JK
authors.lastname: Plichta
authors.affiliation: Department of Pathology, Loyola University Health Systems, 2160 S. First Avenue, Maywood, IL 60153, USA.
authors.forename: Anjali S
authors.initials: AS
authors.lastname: Godambe
authors.affiliation: Stritch School of Medicine, Loyola University Medical Center, 2160 S. First Avenue, Maywood, IL 60153, USA.
authors.forename: Zachary
authors.initials: Z
authors.lastname: Fridirici
authors.affiliation: Department of Pathology, Loyola University Health Systems, 2160 S. First Avenue, Maywood, IL 60153, USA.
authors.forename: Sherri
authors.initials: S
authors.lastname: Yong
authors.affiliation: Department of Preventive Medicine, Loyola University Medical Center, 2160 S. First Avenue, Maywood, IL 60153, USA.
authors.forename: James M
authors.initials: JM
authors.lastname: Sinacore
authors.affiliation: Department of Surgery, Loyola University Health Systems, 2160 S. First Avenue, Maywood, IL 60153, USA.
authors.forename: Gerard J
authors.initials: GJ
authors.lastname: Abood
authors.affiliation: Department of Surgery, Loyola University Health Systems, 2160 S. First Avenue, Maywood, IL 60153, USA.
authors.forename: Gerard V
authors.initials: GV
authors.lastname: Aranha
references.citation: J Am Coll Surg. 2010 May;210(5):797-805.e1, 805-7
references.pmid: 20421053
references.citation: Pancreas. 2006 Oct;33(3):240-5
references.pmid: 17003644
references.citation: Ann Surg. 2011 Aug;254(2):302-10
references.pmid: 21494118
references.citation: J Am Coll Surg. 2011 Nov;213(5):579-588, 588.e1-2
references.pmid: 21925905
references.citation: World J Surg. 2011 Sep;35(9):2118-24
references.pmid: 21717240
references.citation: Ann Surg Oncol. 2008 Jan;15(1):165-74
references.pmid: 17896141
references.citation: Surgery. 2011 Jul;150(1):83-90
references.pmid: 21683860
references.citation: Cancer. 2010 Dec 1;116(23):5374-82
references.pmid: 20715162
references.citation: Eur J Surg Oncol. 2010 Feb;36(2):155-9
references.pmid: 19854606
references.citation: J Am Coll Surg. 2010 Aug;211(2):196-204
references.pmid: 20670857
references.citation: Hepatogastroenterology. 2009 May-Jun;56(91-92):908-13
references.pmid: 19621727
references.citation: Br J Surg. 2009 Aug;96(8):919-25
references.pmid: 19591163
references.citation: Am J Surg. 2009 Mar;197(3):348-52
references.pmid: 19245913
references.citation: HPB (Oxford). 2014 Jun;16(6):582-91
references.pmid: 23777362
references.citation: Ann Surg. 2010 Jun;251(6):1070-8
references.pmid: 20485149
references.citation: J Gastrointest Surg. 2014 Feb;18(2):340-7
references.pmid: 24272772
references.citation: Turk Patoloji Derg. 2011 Jan;27(1):17-22
references.pmid: 21469422
references.citation: Ann Surg Oncol. 2008 Nov;15(11):3178-86
references.pmid: 18712568
references.citation: Ann Surg Oncol. 2012 Jan;19(1):169-75
references.pmid: 21761104
references.citation: Ann Surg. 1997 May;225(5):590-9; discussion 599-600
references.pmid: 9193186
references.citation: J Gastrointest Surg. 2012 Jan;16(1):113-20; discussion 120
references.pmid: 22005894
references.citation: Ann Surg. 2008 Dec;248(6):968-78
references.pmid: 19092341
references.citation: Int J Radiat Oncol Biol Phys. 2011 Dec 1;81(5):1328-35
references.pmid: 20934270
references.citation: J Am Coll Surg. 2011 Jul;213(1):45-52; discussion 52-3
references.pmid: 21601490
references.citation: Ann Surg. 2008 Jul;248(1):97-103
references.pmid: 18580212
references.citation: Br J Surg. 2006 Oct;93(10):1232-7
references.pmid: 16804874
references.citation: Surgery. 2012 Sep;152(3 Suppl 1):S103-11
references.pmid: 22766366
references.citation: J Gastrointest Surg. 2008 Jan;12(1):77-85
references.pmid: 17701264
references.citation: Ups J Med Sci. 2008;113(1):57-64
references.pmid: 18521799
references.citation: Surgery. 2007 May;141(5):610-8
references.pmid: 17462460
references.citation: Surgery. 2006 Nov;140(5):764-72
references.pmid: 17084719
references.citation: Br J Surg. 2010 Aug;97(8):1269-78
references.pmid: 20602499
references.citation: Hepatogastroenterology. 2004 Nov-Dec;51(60):1832-7
references.pmid: 15532837
references.citation: Hepatogastroenterology. 2010 May-Jun;57(99-100):646-52
references.pmid: 20698243
references.citation: J Chronic Dis. 1984;37(9-10):721-31
references.pmid: 6501544
references.citation: BMC Med Res Methodol. 2012 Jan 03;12:2
references.pmid: 22214198
references.citation: Eur J Surg Oncol. 2011 Jan;37(1):60-4
references.pmid: 21094016
references.citation: Indian J Endocrinol Metab. 2011 Jul;15(Suppl 1):S25-32
references.pmid: 21847450
references.citation: Langenbecks Arch Surg. 2008 Nov;393(6):883-90
references.pmid: 18266003
references.citation: World J Surg. 2007 May;31(5):1135-41
references.pmid: 17420962
references.citation: Ann Surg Oncol. 2010 Apr;17(4):991-7
references.pmid: 20108122
references.citation: J Surg Oncol. 2011 Nov 1;104(6):629-33
references.pmid: 21713779
references.citation: BMC Cancer. 2008 Jun 11;8:170
references.pmid: 18547417
references.citation: HPB (Oxford). 2010 Mar;12(2):101-8
references.pmid: 20495653
references.citation: Onkologie. 2010;33(3):101-5
references.pmid: 20215800
references.citation: J Clin Oncol. 2005 Jul 1;23(19):4322-9
references.pmid: 15781880
references.citation: Br J Surg. 2012 Aug;99(8):1036-49
references.pmid: 22517199