Prognostic relevance of lymph node ratio and number of resected nodes after curative resection of ampulla of Vater carcinoma

Massimo Falconi, Stefano Crippa, Ismael Domínguez, Giuliano Barugola, Paola Capelli, Stefano Marcucci, Stefania Beghelli, Aldo Scarpa, Claudio Bassi, Paolo Pederzoli

Research output: Contribution to journalArticle

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.

Original languageEnglish
Pages (from-to)3178-3186
Number of pages9
JournalAnnals of Surgical Oncology
Volume15
Issue number11
DOIs
Publication statusPublished - Nov 2008

Fingerprint

Ampulla of Vater
Lymph Nodes
Carcinoma
Survival
Neoplasm Metastasis
Recurrence
Pancreaticoduodenectomy
Multivariate Analysis
Survival Rate
Demography
Pathology

Keywords

  • Ampullary cancer
  • Lymph node ratio
  • Lymphadenectomy
  • Prognosis
  • Staging
  • Surgery

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

Prognostic relevance of lymph node ratio and number of resected nodes after curative resection of ampulla of Vater carcinoma. / Falconi, Massimo; Crippa, Stefano; Domínguez, Ismael; Barugola, Giuliano; Capelli, Paola; Marcucci, Stefano; Beghelli, Stefania; Scarpa, Aldo; Bassi, Claudio; Pederzoli, Paolo.

In: Annals of Surgical Oncology, Vol. 15, No. 11, 11.2008, p. 3178-3186.

Research output: Contribution to journalArticle

Falconi, M, Crippa, S, Domínguez, I, Barugola, G, Capelli, P, Marcucci, S, Beghelli, S, Scarpa, A, Bassi, C & Pederzoli, P 2008, 'Prognostic relevance of lymph node ratio and number of resected nodes after curative resection of ampulla of Vater carcinoma', Annals of Surgical Oncology, vol. 15, no. 11, pp. 3178-3186. https://doi.org/10.1245/s10434-008-0099-4
Falconi, Massimo ; Crippa, Stefano ; Domínguez, Ismael ; Barugola, Giuliano ; Capelli, Paola ; Marcucci, Stefano ; Beghelli, Stefania ; Scarpa, Aldo ; Bassi, Claudio ; Pederzoli, Paolo. / Prognostic relevance of lymph node ratio and number of resected nodes after curative resection of ampulla of Vater carcinoma. In: Annals of Surgical Oncology. 2008 ; Vol. 15, No. 11. pp. 3178-3186.
@article{9768996701b04179898d56b32ada50cf,
title = "Prognostic relevance of lymph node ratio and number of resected nodes after curative resection of ampulla of Vater carcinoma",
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.",
keywords = "Ampullary cancer, Lymph node ratio, Lymphadenectomy, Prognosis, Staging, Surgery",
author = "Massimo Falconi and Stefano Crippa and Ismael Dom{\'i}nguez and Giuliano Barugola and Paola Capelli and Stefano Marcucci and Stefania Beghelli and Aldo Scarpa and Claudio Bassi and Paolo Pederzoli",
year = "2008",
month = "11",
doi = "10.1245/s10434-008-0099-4",
language = "English",
volume = "15",
pages = "3178--3186",
journal = "Annals of Surgical Oncology",
issn = "1068-9265",
publisher = "Springer New York LLC",
number = "11",

}

TY - JOUR

T1 - Prognostic relevance of lymph node ratio and number of resected nodes after curative resection of ampulla of Vater carcinoma

AU - Falconi, Massimo

AU - Crippa, Stefano

AU - Domínguez, Ismael

AU - Barugola, Giuliano

AU - Capelli, Paola

AU - Marcucci, Stefano

AU - Beghelli, Stefania

AU - Scarpa, Aldo

AU - Bassi, Claudio

AU - Pederzoli, Paolo

PY - 2008/11

Y1 - 2008/11

N2 - 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.

AB - 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.

KW - Ampullary cancer

KW - Lymph node ratio

KW - Lymphadenectomy

KW - Prognosis

KW - Staging

KW - Surgery

UR - http://www.scopus.com/inward/record.url?scp=55149093409&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=55149093409&partnerID=8YFLogxK

U2 - 10.1245/s10434-008-0099-4

DO - 10.1245/s10434-008-0099-4

M3 - Article

C2 - 18712568

AN - SCOPUS:55149093409

VL - 15

SP - 3178

EP - 3186

JO - Annals of Surgical Oncology

JF - Annals of Surgical Oncology

SN - 1068-9265

IS - 11

ER -