title: Factors influencing lymph node metastasis in patients with ampullary adenocarcinoma.
abstract: OBJECTIVE
  In cases of ampullary carcinoma, lymph node involvement affects the selection of treatment strategies. This study aimed to identify clinicopathologic features of ampullary carcinoma with lymph node metastases.
  
  
  METHODS
  The records of 74 consecutive patients with ampullary adenocarcinoma who underwent pancreaticoduodenectomy (PD) with regional lymph node dissection were retrospectively analyzed.
  
  
  RESULTS
  Twenty-two patients (30%) with lymph node metastasis had significantly worse survival after resection than those without lymph node metastasis (p = 0.017). Univariate analyses revealed that preoperative biliary drainage; elevated serum carbohydrate antigen 19-9 (≥36 U/ml); moderate-to-poor pathologic grade (G2/3); perineural, vascular, lymphatic, pancreas, and duodenal invasion; and T category were significantly associated with lymph node metastasis. In multivariate analysis, only pathologic grade (G2/3) remained significantly associated with lymph node metastasis (hazard ratio, 6.51; p = 0.035). In sub-classified analysis for T category, lymph node metastasis was found in 5 of 22 cases (22.7%) of T1 tumors. Four of five cases with lymph node metastases had a dominant G2/3 component, whereas only 2 of 17 cases without lymph node metastases had a G2/3 component in T1 tumors (p = 0.0036).
  
  
  CONCLUSIONS
  Pathologic grade (G2/3) was significantly and independently associated with lymph node metastasis and was also a significant predictor in T1 tumor cases.
authors.affiliation: Department of Gastroenterological Surgery, Faculty of Medicine, Kagawa University, Miki-cho, Kagawa, Japan.
authors.forename: Keiichi
authors.initials: K
authors.lastname: Okano
authors.forename: Eisuke
authors.initials: E
authors.lastname: Asano
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Kushida
authors.forename: Hideki
authors.initials: H
authors.lastname: Kamada
authors.forename: Hirohito
authors.initials: H
authors.lastname: Mori
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Suzuki
mesh_terms: D000230:Adenocarcinoma / Q000556:secondary* / Q000601:surgery; D000368:Aged; D000369:Aged, 80 and over; D014670:Ampulla of Vater; D018395:CA-19-9 Antigen / Q000097:blood; D003138:Common Bile Duct Neoplasms / Q000473:pathology* / Q000601:surgery; D004322:Drainage; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D016577:Pancreaticoduodenectomy; D011300:Preoperative Care; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate
chemical_list: D018395:CA-19-9 Antigen