Prognostic Value of the Metastatic Lymph Node Ratio in Patients With Resectable Carcinoma of Ampulla of Vater.
Patients with carcinoma of the ampulla of Vater (CAV) have better outcomes among periampullary malignancies. However, little is known about the metastatic lymph node ratio (LNR) as a prognostic factor for resectable CAV. We retrospectively reviewed our CAV patients undergoing curative surgery and analyzed their prognostic factors.A total of 212 CAV patients who received radical surgery at Chang Gung Memorial Hospital, Linkou, between 2000 and 2010 were admitted in this study. The lymph node ratio was defined as the number of metastatic lymph nodes (LNs) divided by the total number of LNs removed. The patients' demographic data, comorbidities, operation type, and tumor features were analyzed retrospectively for survival prediction of patients.The median age of the patients was 62 years, and 57% of the patients were men. The surgical procedure was standard pancreaticoduodenectomy and pylorus-preserving pancreaticoduodenectomy in 53% and 47% of the patients, respectively. The median follow-up duration was 32.6 months, and 50% of the patients had died by the end of the study. The median overall survival time (OS) and disease-free survival time (DFS) were 65.8 and 33.7 months, respectively. In multivariate analysis, patients with a metastatic LNR >0.056 had a significantly poor prognosis in both OS and DFS.A metastatic LNR >0.056 predicted a poor DFS and OS in CAV patients after radical surgery. Greater awareness on the impact of metastatic LNR may help clinicians provide appropriate adjuvant treatment for high-risk CAV patients.
From the Department of General Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan (C-HH, C-YT, J-TH, C-NY, Y-YJ, T-SY, K-HL), Department of Anatomical Pathology, Chang Gung Memorial Hospital, Linkou, Taiwan (T-DC), Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taiwan (T-SY, W-CC); and Department of Hematology and Oncology, Chang Gung Memorial Hospital, Linkou, Taiwan (W-CC).
Chih-Ho
CH
Hsu
Tai-Di
TD
Chen
Chun-Yi
CY
Tsai
Jun-Te
JT
Hsu
Chun-Nan
CN
Yeh
Yi-Yin
YY
Jan
Ta-Sen
TS
Yeh
Wen-Chi
WC
Chou
Keng-Hao
KH
Liu
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014670:Ampulla of Vater; D002277:Carcinoma / Q000401:mortality / Q000556:secondary*; D003138:Common Bile Duct Neoplasms / Q000401:mortality / Q000473:pathology*; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate