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World Journal of Surgical Oncology

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Open Access 01-12-2015 | Research

The role of lymph nodes in predicting the prognosis of ampullary carcinoma after curative resection

Authors: Shih-Chin Chen, Yi-Ming Shyr, Shu-Cheng Chou, Shin-E Wang

Published in: World Journal of Surgical Oncology | Issue 1/2015

Abstract

Background

Lymph node involvement is one of the well-demonstrated prognostic factors in ampullary carcinoma. The aim of this study is to clarify the role of lymph nodes in predicting the survival outcome of ampullary carcinoma.

Methods

A cohort of consecutive curative pancreaticoduodenectomies for ampullary carcinoma from 1999 to 2014 was retrospectively analyzed. The effect of node-associated variables, including lymph node status, positive lymph node number, total harvested lymph node (THLN) number, and lymph node ratio (LNR) was examined using univariate and multivariate analyses for survival outcome prediction.

Results

In 194 evaluable patients, univariate analysis demonstrated that stage, cell differentiation, perineural invasion, and nodal status were significant conventional prognostic factors. Concerning the node-associated variables, positive nodal status, positive lymph node number ≥2, THLN number <14, and LNR ≥0.15 were significantly associated with poorer survival outcomes, with a 5-year survival rate of 20.3, 38.9, 25.4, and 18 %, respectively. By multivariate analysis, nodal status and THLN number were two independent predictors of survival. The most favorable 5-year survival rate was 84.4 % in patients with negative nodal involvement and THLN number ≥14, compared with the poorest 5-year survival rate of 16.1 % in those with positive nodal status and THLN number <14.

Conclusions

Tumor biology reflected by lymph node status is the most important independent prognostic factor; nevertheless, surgical radicality based on THLN number also plays a significant role in the survival outcome for patients with ampullary carcinoma after curative pancreaticoduodenectomy.

Andersen HB, Baden H, Brahe NE, Burcharth F. Pancreaticoduodenectomy for periampullary adenocarcinoma. J Am Coll Surg. 1994;179:545–52.PubMed

Whipple AO, Parsons WB, Mullins CR. Treatment of carcinoma of the ampulla of Vater. Ann Surg. 1935;102:763–79.PubMedCentralPubMedCrossRef

Chen SC, Shyr YM, Wang SE. Longterm survival after pancreaticoduodenectomy for periampullary adenocarcinomas. HPB (Oxford). 2013;15:951–7.CrossRef

Westgaard A, Tafjord S, Farstad IN, Cvancarova M, Eide TJ, Mathisen O, et al. Pancreatobiliary versus intestinal histologic type of differentiation is an independent prognostic factor in resected periampullary adenocarcinoma. BMC Cancer. 2008;8:170.PubMedCentralPubMedCrossRef

Cameron JL, Riall TS, Coleman J, Belcher KA. One thousand consecutive pancreaticoduodenectomies. Ann Surg. 2006;244:10–5.PubMedCentralPubMedCrossRef

Sommerville CA, Limongelli P, Pai M, Ahmad R, Stamp G, Habib NA, et al. Survival analysis after pancreatic resection for ampullary and pancreatic head carcinoma: an analysis of clinicopathological factors. J Surg Oncol. 2009;100:651–6.PubMedCrossRef

Kim RD, Kundhal PS, McGilvray ID, Cattral MS, Taylor B, Langer B, et al. Predictors of failure after pancreaticoduodenectomy for ampullary carcinoma. J Am Coll Surg. 2006;202:112–9.PubMedCrossRef

Lemke J, Schafer D, Sander S, Henne-Bruns D, Kornmann M. Survival and prognostic factors in pancreatic and ampullary cancer. Anticancer Res. 2014;34:3011–20.PubMed

Pomianowska E, Westgaard A, Mathisen O, Clausen OP, Gladhaug IP. Prognostic relevance of number and ratio of metastatic lymph nodes in resected pancreatic, ampullary, and distal bile duct carcinomas. Ann Surg Oncol. 2013;20:233–41.PubMedCrossRef

10.

Allema JH, Reinders ME, van Gulik TM, van Leeuwen DJ, Verbeek PC, de Wit LT, et al. Results of pancreaticoduodenectomy for ampullary carcinoma and analysis of prognostic factors for survival. Surgery. 1995;117:247–53.PubMedCrossRef

11.

Klein F, Jacob D, Bahra M, Pelzer U. Prognostic factors for long-term survival in patients with ampullary carcinoma: the results of a 15-year observation period after pancreaticoduodenectomy. HPB Surg. 2014;2014:970234.PubMedCentralPubMedCrossRef

12.

Kure S, Kaneko T, Takeda S, Inoue S, Nakao A. Analysis of long-term survivors after surgical resection for invasive pancreatic cancer. HPB (Oxford). 2005;7:129–34.CrossRef

13.

Katz MH, Wang H, Fleming JB, Sun CC, Hwang RF, Wolff RA, et al. Long-term survival after multidisciplinary management of resected pancreatic adenocarcinoma. Ann Surg Oncol. 2009;16:836–47.PubMedCentralPubMedCrossRef

14.

Maithel SK, Khalili K, Dixon E, Guindi M, Callery MP, Cattral MS, et al. Impact of regional lymph node evaluation in staging patients with periampullary tumors. Ann Surg Oncol. 2007;14:202–10.PubMedCrossRef

15.

Edge SB BD, Compton CC, Fritz AG, Greene FL, Trotti A, editors: AJCC cancer staging manual. 7th ed. New York, NY: Springer. 2010.

16.

Zhang H, Wang W, Diao D, Cheng Y, Song Y, Zhu K, et al. Ratio of metastatic to examined lymph nodes, a helpful staging system and independent prognostic factor of esophagogastric junction cancer. PLoS One. 2013;8:e73238.PubMedCentralPubMedCrossRef

17.

He Z, Wu S, Li Q, Lin Q, Xu J. Use of the metastatic lymph node ratio to evaluate the prognosis of esophageal cancer patients with node metastasis following radical esophagectomy. PLoS One. 2013;8:e73446.PubMedCentralPubMedCrossRef

18.

Bando E, Yonemura Y, Taniguchi K, Fushida S, Fujimura T, Miwa K. Outcome of ratio of lymph node metastasis in gastric carcinoma. Ann Surg Oncol. 2002;9:775–84.PubMedCrossRef

19.

Marchet A, Mocellin S, Ambrosi A, Morgagni P, Garcea D, Marrelli D, et al. The ratio between metastatic and examined lymph nodes (N ratio) is an independent prognostic factor in gastric cancer regardless of the type of lymphadenectomy: results from an Italian multicentric study in 1853 patients. Ann Surg. 2007;245:543–52.PubMedCentralPubMedCrossRef

20.

Jiang K, Zhu Y, Liu Y, Ye Y, Xie Q, Yang X, et al. Lymph node ratio as an independent prognostic indicator in stage III colorectal cancer: especially for fewer than 12 lymph nodes examined. Tumour Biol. 2014;35:11685–90.PubMedCrossRef

21.

Costi R, Beggi F, Reggiani V, Ricco M, Crafa P, Bersanelli M, et al. Lymph node ratio improves TNM and Astler-Coller’s assessment of colorectal cancer prognosis: an analysis of 761 node positive cases. J Gastrointest Surg. 2014;18:1824–36.PubMedCrossRef

22.

Madbouly KM, Abbas KS, Hussein AM. Metastatic lymph node ratio in stage III rectal carcinoma is a valuable prognostic factor even with less than 12 lymph nodes retrieved: a prospective study. Am J Surg. 2014;207:824–31.PubMedCrossRef

23.

Riediger H, Keck T, Wellner U, zur Hausen A, Adam U, Hopt UT, et al. The lymph node ratio is the strongest prognostic factor after resection of pancreatic cancer. J Gastrointest Surg. 2009;13:1337–44.PubMedCrossRef

24.

Tol JA, Brosens LA, van Dieren S, van Gulik TM, Busch OR, Besselink MG, et al. Impact of lymph node ratio on survival in patients with pancreatic and periampullary cancer. Br J Surg. 2015;102:237–45.PubMedCrossRef

25.

Falconi M, Crippa S, Dominguez I, Barugola G, Capelli P, Marcucci S, et al. Prognostic relevance of lymph node ratio and number of resected nodes after curative resection of ampulla of Vater carcinoma. Ann Surg Oncol. 2008;15:3178–86.PubMedCrossRef

26.

Pawlik TM, Gleisner AL, Cameron JL, Winter JM, Assumpcao L, Lillemoe KD, et al. Prognostic relevance of lymph node ratio following pancreaticoduodenectomy for pancreatic cancer. Surgery. 2007;141:610–8.PubMedCrossRef

27.

Petrelli F, Borgonovo K, Barni S. The emerging issue of ratio of metastatic to resected lymph nodes in gastrointestinal cancers: an overview of literature. Eur J Surg Oncol. 2011;37:836–47.PubMedCrossRef

28.

Shamseddine AI, Mukherji D, Melki C, Elias E, Eloubeidi M, Dimassi H, et al. Lymph node ratio is an independent prognostic factor after resection of periampullary malignancies: data from a tertiary referral center in the middle East. Am J Clin Oncol. 2014;37:13–8.PubMedCrossRef

29.

House MG, Gonen M, Jarnagin WR, D'Angelica M, DeMatteo RP, Fong Y, et al. Prognostic significance of pathologic nodal status in patients with resected pancreatic cancer. J Gastrointest Surg. 2007;11:1549–55.PubMedCrossRef

30.

Partelli S, Crippa S, Capelli P, Neri A, Bassi C, Zamboni G, et al. Adequacy of lymph node retrieval for ampullary cancer and its association with improved staging and survival. World J Surg. 2013;37:1397–404.PubMedCrossRef

31.

Vuarnesson H, Lupinacci RM, Semoun O, Svrcek M, Julie C, Balladur P, et al. Number of examined lymph nodes and nodal status assessment in pancreaticoduodenectomy for pancreatic adenocarcinoma. Eur J Surg Oncol. 2013;39:1116–21.PubMedCrossRef

32.

Smith DD, Schwarz RR, Schwarz RE. Impact of total lymph node count on staging and survival after gastrectomy for gastric cancer: data from a large US-population database. J Clin Oncol. 2005;23:7114–24.PubMedCrossRef

33.

Cserni G, Vinh-Hung V, Burzykowski T. Is there a minimum number of lymph nodes that should be histologically assessed for a reliable nodal staging of T3N0M0 colorectal carcinomas? J Surg Oncol. 2002;81:63–9.PubMedCrossRef

34.

Slidell MB, Chang DC, Cameron JL, Wolfgang C, Herman JM, Schulick RD, et al. Impact of total lymph node count and lymph node ratio on staging and survival after pancreatectomy for pancreatic adenocarcinoma: a large, population-based analysis. Ann Surg Oncol. 2008;15:165–74.PubMedCrossRef

35.

Ito K, Ito H, Allen PJ, Gonen M, Klimstra D, D'Angelica MI, et al. Adequate lymph node assessment for extrahepatic bile duct adenocarcinoma. Ann Surg. 2010;251:675–81.PubMedCrossRef

36.

Sakata J, Shirai Y, Wakai T, Yokoyama N, Sakata E, Akazawa K, et al. Number of positive lymph nodes independently affects long-term survival after resection in patients with ampullary carcinoma. Eur J Surg Oncol. 2007;33:346–51.PubMedCrossRef

37.

Sierzega M, Nowak K, Kulig J, Matyja A, Nowak W, Popiela T. Lymph node involvement in ampullary cancer: the importance of the number, ratio, and location of metastatic nodes. J Surg Oncol. 2009;100:19–24.PubMedCrossRef

38.

Sakata J, Shirai Y, Wakai T, Ajioka Y, Akazawa K, Hatakeyama K. Assessment of the nodal status in ampullary carcinoma: the number of positive lymph nodes versus the lymph node ratio. World J Surg. 2011;35:2118–24.PubMedCrossRef

39.

Zhou J, Zhang Q, Li P, Shan Y, Zhao D, Cai J. Prognostic relevance of number and ratio of metastatic lymph nodes in resected carcinoma of the ampulla of Vater. Chin J Cancer Res. 2013;25:735–42.PubMedCentralPubMed

40.

Wang SE, Shyr YM, Su CH, Chen TH, Wu CW. Palliative pancreaticoduodenectomy in pancreatic and periampullary adenocarcinomas. Pancreas. 2012;41:882–7.PubMedCrossRef

41.

Sakata E, Shirai Y, Yokoyama N, Wakai T, Sakata J, Hatakeyama K. Clinical significance of lymph node micrometastasis in ampullary carcinoma. World J Surg. 2006;30:985–91.PubMedCrossRef

42.

Le Voyer TE, Sigurdson ER, Hanlon AL, Mayer RJ, Macdonald JS, Catalano PJ, et al. Colon cancer survival is associated with increasing number of lymph nodes analyzed: a secondary survey of intergroup trial INT-0089. J Clin Oncol. 2003;21:2912–9.PubMedCrossRef

Title: The role of lymph nodes in predicting the prognosis of ampullary carcinoma after curative resection
Authors: Shih-Chin Chen
Yi-Ming Shyr
Shu-Cheng Chou
Shin-E Wang
Publication date: 01-12-2015
Publisher: BioMed Central
Published in: World Journal of Surgical Oncology / Issue 1/2015
Electronic ISSN: 1477-7819
DOI: https://doi.org/10.1186/s12957-015-0643-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

The role of lymph nodes in predicting the prognosis of ampullary carcinoma after curative resection

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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