The Prognostic Relevance of the Number and Location of Positive Lymph Nodes for Ampulla of Vater Carcinoma
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ORIGINAL SCIENTIFIC REPORT
The Prognostic Relevance of the Number and Location of Positive Lymph Nodes for Ampulla of Vater Carcinoma Satoshi Matsui1 • Yusuke Yamamoto1 • Teiichi Sugiura1 • Yukiyasu Okamura1 • Takaaki Ito1 Ryo Ashida1 • Katsuhisa Ohgi1 • Taisuke Imamura1 • Katsuhiko Uesaka1
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Accepted: 18 August 2020 Ó Socie´te´ Internationale de Chirurgie 2020
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 C3 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 C 3 LNMs (hazards ratio [HR], 3.22) and LNM except for pancreatic head region (HR, 4.27) were individually independent worse prognostic factors. Conclusions C3 LNMs and regional LNM except for pancreatic head region were associated with poor prognosis comparable to that of the patients with M1.
Introduction Ampulla of Vater carcinoma (AC) is rare, accounting for only 0.2% of gastrointestinal cancers and approximately 7% of all periampullary cancers [1]. AC presents with symptoms in the early phase of the disease course due to biliary obstruction; therefore, it has been known to have a comparatively favorable prognosis among periampullary & Yusuke Yamamoto [email protected] 1
Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Sunto-Nagaizumi, Shizuoka 4118777, Japan
malignancies, with reported 5-year OS rates of 30–70% after resection [2, 3]. However, the low incidence of AC makes it difficult to establish evidence on clinical practice and outcomes. Lymph node metastasis (LNM) has been recognized as one of the pivotal prognostic factors [4]. LNMs are observed in 20–50% of resected AC, and survival rates of patients with LNM decrease by more than half compared to that of the patients without LNM [5–7]. Moreover, previous studies reported that the number of LNM is associated with survival; however, the cutoff values varied among these studies [8–10]. The current 8t
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