A High Positive Lymph Node Ratio is Associated with Distant Recurrence after Surgical Resection of Ampullary Carcinoma
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ORIGINAL ARTICLE
A High Positive Lymph Node Ratio is Associated with Distant Recurrence after Surgical Resection of Ampullary Carcinoma Christina L. Roland & Matthew H. G. Katz & Graciela M. N. Gonzalez & Peter W. T. Pisters & Jean-Nicolas Vauthey & Robert A. Wolff & Christopher H. Crane & Jeffrey E. Lee & Jason B. Fleming
Received: 27 June 2012 / Accepted: 14 August 2012 / Published online: 23 August 2012 # 2012 The Society for Surgery of the Alimentary Tract
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. Keywords Ampullary carcinoma . Lymph node ratio . Recurrence
Introduction Although patients with ampullary carcinoma (AC) have improved survival compared to patients with pancreatic
This study was presented as a Poster Presentation at the Society of Surgical Oncology Annual Meeting in Orlando, FL, March 21–25, 2012. C. L. Roland : M. H. G. Katz : P. W. T. Pisters : J.-N. Vauthey : J. E. Lee : J. B. Fleming (*) Division of Surgery, Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030, USA e-mail: [email protected] G. M. N. Gonzalez Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, TX, USA
R. A. Wolff Department of Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
C. H. Crane Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
J Gastrointest Surg (2012) 16:2056–2063
adenocarcinoma, up to 40 % of patients develop recurrent disease, highlighting the importance of adjuvant therapy.1 Several factors have been associated with outcomes for patients with AC, including advanced T-stage, tumor grade, pancreatobiliary histologic subtype, t
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