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A High Positive Lymph Node Ratio is Associated with Distant Recurrence after Surgical Resection of Ampullary Carcinoma

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Journal of Gastrointestinal Surgery Aims and scope

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Abstract

Background

For ampullary carcinoma (AC), the lymph node ratio (LNR) has been associated with overall survival. However, the use of the LNR to predict distant recurrence risk remains unknown. The purpose of this study was to determine if the LNR is associated with distant recurrence risk.

Methods

One hundred forty three patients with AC who underwent pancreaticoduodenectomy between 1989 and 2011 were identified from a single-institution prospective database. Data on clinicopathologic factors and recurrence were analyzed.

Results

At a median follow-up of 43 months (62 months for survivors), 55 patients (38 %) had developed recurrent disease, with a median time to recurrence of 13 months. Patients with a LNR ≥0.15 were more likely to have T3/4 tumors, advanced stage lymphovascular (LVI), or perineural invasion (PNI) and develop recurrent disease. Univariate analysis demonstrated that T-stage, lymph node status, AJCC stage, LVI, PNI, and LNR were significantly associated with decreased time to distant recurrence (TTDR). In multivariate stepwise regression, only LNR and LVI were significantly associated with decreased TTDR.

Conclusions

A high positive LNR is associated with distant recurrence after surgical resection of AC. Given the high risk of disease recurrence, consideration for adjuvant therapy is warranted in patients with a LNR ≥0.15.

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Acknowledgments

This research has been supported by the various donor funds for Pancreatic Cancer Research at the University of Texas M.D. Anderson Cancer Center and the NIH through the M.D. Anderson Cancer Center Support Grant CA0166672 and the Ruth L. Kirschstein National Research Service Award T32CA009599-23.

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Authors and Affiliations

  1. Division of Surgery, Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX, 77030, USA

    Christina L. Roland, Matthew H. G. Katz, Peter W. T. Pisters, Jean-Nicolas Vauthey, Jeffrey E. Lee & Jason B. Fleming

  2. Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Graciela M. N. Gonzalez

  3. Department of Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Robert A. Wolff

  4. Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Christopher H. Crane

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  1. Christina L. Roland
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Correspondence to Jason B. Fleming.

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Roland, C.L., Katz, M.H.G., Gonzalez, G.M.N. et al. A High Positive Lymph Node Ratio is Associated with Distant Recurrence after Surgical Resection of Ampullary Carcinoma. J Gastrointest Surg 16, 2056–2063 (2012). https://doi.org/10.1007/s11605-012-2015-2

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  • DOI: https://doi.org/10.1007/s11605-012-2015-2

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