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Prognostic Relevance of Lymph Node Ratio and Number of Resected Nodes after Curative Resection of Ampulla of Vater Carcinoma

  • Hepatic and Pancreatic Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Nodal metastasis is considered a major prognostic factor in patients with ampulla of Vater carcinoma (AVC). No study has investigated the significance of the ratio between metastatic and resected/examined lymph nodes (LNR) in patients with AVC.

Methods

Demographic, operative, and pathology data, including number of resected/evaluated nodes and LNR, were collected from patients who underwent pancreaticoduodenectomy with radical intent for invasive AVC from 1990 to 2005. Survival rates and recurrence patterns were evaluated and predictors were identified.

Results

In 90 evaluable patients (51 males, 39 females, median age 62.5 years), 5-year disease-specific survival (DSS) was 61%. The median number of resected/evaluated nodes was 16 (range: 5–47); 50% of the patients had nodal metastases. The 5-year DSS according to LNR was 75%, 49%, 38%, and 0% for LNR = 0, LNR >0 and ≤0.2, LNR >0.2, and ≤0.4, and LNR >0.4 (P = 0.002), respectively. The 5-year DSS was 81% in patients with >16 resected/evaluated nodes compared with 45% in those with ≤16 resected/evaluated nodes (P = 0.001). On multivariate analysis LNR and a number of resected/evaluated nodes >16 were significant predictors of survival; a number of resected/evaluated nodes >16 was also the only independent predictor of recurrence.

Conclusions

After curative resection for AVC, LNR and a cutoff of 16 resected/evaluated nodes are powerful prognostic factors. LNR might represent a major parameter for patient stratification in adjuvant treatment trials.

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Acknowledgments

This study was supported by: Fondazione Italiana per le Malattie del Pancreas (FIMP), Fondazione Cariverona, Verona, Italy (Bando 2004); European Community FP6 Program, Grant PL018771 MolDiagPaca; Associazione Italiana Ricerca Cancro (AIRC), Milano, Italy; Fondazione Giorgio Zanotto, Verona, Italy.

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Authors and Affiliations

  1. Chirurgia Generale B (Pancreas Unit), Department of Surgery, University of Verona, Policlinico GB Rossi, Piazzale LA Scuro, 37134, Verona, Italy

    Massimo Falconi MD, Stefano Crippa MD, Giuliano Barugola MD, Stefano Marcucci MD, Claudio Bassi MD & Paolo Pederzoli MD

  2. Department of Surgery (ID), Instituto Nacional de Ciencias Medicas y Nutricion “Salvador Zubiran”, Mexico City, Mexico

    Ismael Domínguez MD

  3. Department of Pathology, University of Verona, Policlinico GB Rossi, Verona, Italy

    Paola Capelli MD & Aldo Scarpa MD

  4. IRCCS Istituto Oncologico Veneto, Padova, Italy

    Stefania Beghelli MD

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  1. Massimo Falconi MD
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  2. Stefano Crippa MD
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Correspondence to Massimo Falconi MD.

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Falconi, M., Crippa, S., Domínguez, I. et al. Prognostic Relevance of Lymph Node Ratio and Number of Resected Nodes after Curative Resection of Ampulla of Vater Carcinoma. Ann Surg Oncol 15, 3178–3186 (2008). https://doi.org/10.1245/s10434-008-0099-4

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  • DOI: https://doi.org/10.1245/s10434-008-0099-4

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