Abstract
Background
Lymph node metastasis (LNM) has been regarded as one of the prognostic factors in patients with ampulla of Vater carcinoma (AC). However, the consensus about an optimal cutoff value of the number of LNMs and the definition of the regional lymph nodes (RLNs) has not been achieved.
Methods
This study included 114 consecutive patients who underwent pancreatoduodenectomy for AC between January 2002 and March 2019.
Results
The minimum p value approach for the greatest difference in the overall survival classified the number of LNM into none (N0, n = 66), from 1 to 2 (N1, n = 32), and ≥3 LNM (N2, n = 11) (p = 0.004). Distant LNM was defined as M1 (n = 5). Significant differences in relapse-free survival (RFS) were found between N0 and N1 (p < 0.001), N1 and N2 (p = 0.047), and N1 and M1 (p = 0.044) but not between N2 and M1 (p = 0.683). Moreover, the patients with regional LNM were classified into two groups: Np group (n = 35, LNM only in pancreatic head region) and Nd group (n = 8, LNM in other regional location). Significant differences in the RFS were found between N0 and Np (p < 0.001), Np and Nd (p = 0.004), and Np and M1 (p = 0.033) but not between Nd and M1 (p = 0.883). A Cox proportional hazards analysis for RFS revealed that ≥ 3 LNMs (hazards ratio [HR], 3.22) and LNM except for pancreatic head region (HR, 4.27) were individually independent worse prognostic factors.
Conclusions
≥3 LNMs and regional LNM except for pancreatic head region were associated with poor prognosis comparable to that of the patients with M1.
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References
Jemal A, Siegel R, Ward E et al (2008) Cancer statistics, 2008. CA Cancer J Clin 58:71–96
Kim K, Chie EK, Jang JY et al (2009) Role of adjuvant chemoradiotherapy for ampulla of Vater cancer. Int J Radiat Oncol Biol Phys 75:436–441
Narang AK, Miller RC, Hsu CC et al (2011) Evaluation of adjuvant chemoradiation therapy for ampullary adenocarcinoma: the Johns Hopkins Hospital-Mayo Clinic collaborative study. Radiat Oncol 6:126
Williams JA, Cubilla A, Maclean BJ et al (1979) Twenty-two year experience with periampullary carcinoma at Memorial Sloan-Kettering Cancer Center. Am J Surg 138:662–665
Chen SC, Shyr YM, Chou SC et al (2015) The role of lymph nodes in predicting the prognosis of ampullary carcinoma after curative resection. World J Surg Oncol 13:224
Balci S, Basturk O, Saka B et al (2015) Substaging Nodal Status in Ampullary Carcinomas has Significant Prognostic Value: proposed Revised Staging Based on an Analysis of 313 Well-Characterized Cases. Ann Surg Oncol 22:4392–4401
Roland CL, Katz MH, Gonzalez GM et al (2012) A high positive lymph node ratio is associated with distant recurrence after surgical resection of ampullary carcinoma. J Gastrointest Surg 16:2056–2063
Choi SB, Kim WB, Song TJ et al (2011) Surgical outcomes and prognostic factors for ampulla of Vater cancer. Scand J Surg 100:92–98
Sommerville CA, Limongelli P, Pai M et al (2009) Survival analysis after pancreatic resection for ampullary and pancreatic head carcinoma: an analysis of clinicopathological factors. J Surg Oncol 100:651–656
Sakata J, Shirai Y, Wakai T et al (2007) Number of positive lymph nodes independently affects long-term survival after resection in patients with ampullary carcinoma. Eur J Surg Oncol 33:346–351
Kang HJ, Eo SH, Kim SC et al (2014) Increased number of metastatic lymph nodes in adenocarcinoma of the ampulla of Vater as a prognostic factor: a proposal of new nodal classification. Surgery 155:74–84
Roder JD, Schneider PM, Stein HJ et al (1995) Number of lymph node metastases is significantly associated with survival in patients with radically resected carcinoma of the ampulla of Vater. Br J Surg 82:1693–1696
Shirai Y, Tsukada K, Ohtani T et al (1996) Carcinoma of the ampulla of Vater: is radical lymphadenectomy beneficial to patients with nodal disease? J Surg Oncol 61:190–194
Kayahara M, Nagakawa T, Ohta T et al (1997) Surgical strategy for carcinoma of the papilla of Vater on the basis of lymphatic spread and mode of recurrence. Surgery 121:611–617
Miyazaki M, Ohtsuka M, Miyakawa S, et al (2015) Classification of biliary tract cancers established by the Japanese Society of Hepato-Biliary-Pancreatic Surgery: 3(rd) English edition. J Hepatobiliary Pancreat Sci 22:181-196
Network NCC NCCN Guidelines, 2019
Kohga A, Yamamoto Y, Sano S et al (2017) Surgical Strategy for T1 Duodenal or Ampullary Carcinoma According to the Depth of Tumor Invasion. Anticancer Res 37:5277–5283
Mazumdar M, Glassman JR (2000) Categorizing a prognostic variable: review of methods, code for easy implementation and applications to decision-making about cancer treatments. Stat Med 19:113–132
Ichikura T, Tomimatsu S, Okusa Y et al (1993) Comparison of the prognostic significance between the number of metastatic lymph nodes and nodal stage based on their location in patients with gastric cancer. J Clin Oncol 11:1894–1900
Kodera Y, Yamamura Y, Shimizu Y et al (1998) The number of metastatic lymph nodes: a promising prognostic determinant for gastric carcinoma in the latest edition of the TNM classification. J Am Coll Surg 187:597–603
Cohen AM, Tremiterra S, Candela F et al (1991) Prognosis of node-positive colon cancer. Cancer 67:1859–1861
Tang R, Wang JY, Chen JS et al (1995) Survival impact of lymph node metastasis in TNM stage III carcinoma of the colon and rectum. J Am Coll Surg 180:705–712
Imamura T, Yamamoto Y, Sugiura T et al (2019) The Prognostic Relevance of the New 8th Edition of the Union for International Cancer Control Classification of TNM Staging for Ampulla of Vater Carcinoma. Ann Surg Oncol 26:1639–1648
Lee JH, Lee KG, Ha TK et al (2011) Pattern analysis of lymph node metastasis and the prognostic importance of number of metastatic nodes in ampullary adenocarcinoma. Am Surg 77:322–329
Sierzega M, Nowak K, Kulig J et al (2009) Lymph node involvement in ampullary cancer: the importance of the number, ratio, and location of metastatic nodes. J Surg Oncol 100:19–24
Kawabata Y, Tanaka T, Nishi T et al (2012) Appraisal of a total meso-pancreatoduodenum excision with pancreaticoduodenectomy for pancreatic head carcinoma. Eur J Surg Oncol 38:574–579
de Castro SM, van Heek NT, Kuhlmann KF et al (2004) Surgical management of neoplasms of the ampulla of Vater: local resection or pancreatoduodenectomy and prognostic factors for survival. Surgery 136:994–1002
Acharya A, Markar SR, Sodergren MH et al (2017) Meta-analysis of Adjuvant Therapy Following Curative Surgery for Periampullary Adenocarcinoma. Br J Surg 104(7):814–822
Valle J, Wasan H, Palmer DH et al (2010) Cisplatin plus gemcitabine versus gemcitabine for biliary tract cancer. N Engl J Med 362:1273–1281
Jin Z, Hartgers ML, Sanhueza CT et al (2018) Prognostic factors and benefits of adjuvant therapy after pancreatoduodenectomy for ampullary adenocarcinoma: mayo Clinic experience. Eur J Surg Oncol 44:677–683
Nassour I, Hynan LS, Christie A et al (2018) Association of adjuvant therapy with improved survival in ampullary cancer: a national cohort study. J Gastrointest Surg 22:695–702
Lee JH, Whittington R, Williams NN et al (2000) Outcome of pancreaticoduodenectomy and impact of adjuvant therapy for ampullary carcinomas. Int J Radiat Oncol Biol Phys 47:945–953
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Matsui, S., Yamamoto, Y., Sugiura, T. et al. The Prognostic Relevance of the Number and Location of Positive Lymph Nodes for Ampulla of Vater Carcinoma. World J Surg 45, 270–278 (2021). https://doi.org/10.1007/s00268-020-05770-1
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DOI: https://doi.org/10.1007/s00268-020-05770-1