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Author Notes:

E-mail: volkan.adsay@emory.edu

The authors would like to thank Allyne Manzo and Lorraine Biedrzycki for assistance with the figures.

DISCLOSURES: None of the authors have no affiliation with, or financial involvement in, any organization with a direct financial interest in the subject matter or materials discussed in the manuscript.

This study was presented in part at the annual meeting of the United States and Canadian Academy of Pathology, San Diego, CA, USA, 1–7 March 2014.

Subjects:

Keywords:

  • Science & Technology
  • Life Sciences & Biomedicine
  • Oncology
  • Surgery
  • METASTATIC LYMPH-NODES
  • NO ADJUVANT CHEMOTHERAPY
  • LONG-TERM SURVIVAL
  • PERIAMPULLARY ADENOCARCINOMA
  • INTESTINAL-TYPE
  • TUMOR LOCATION
  • VATER CANCER
  • BILE-DUCT
  • NUMBER
  • RATIO

Substaging Nodal Status in Ampullary Carcinomas has Significant Prognostic Value: Proposed Revised Staging Based on an Analysis of 313 Well-Characterized Cases

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Journal Title:

Annals of Surgical Oncology

Volume:

Volume 22, Number 13

Publisher:

, Pages 4392-4401

Type of Work:

Article | Post-print: After Peer Review

Abstract:

Background Current nodal staging (N-staging) of am-pullary carcinoma in the TNM staging system distinguishes between node-negative (N0) and node-positive (N1) disease but does not consider the metastatic lymph node (LN) number. Methods Overall, 313 patients who underwent pancreatoduodenectomy for ampullary adenocarcinoma were categorized as N0, N1 (1–2 metastatic LNs), or N2 (≥3 metastatic LNs), as proposed by Kang et al. Clinico-pathological features and overall survival (OS) of the three groups were compared. Results The median number of LNs examined was 11, and LN metastasis was present in 142 cases (45 %). When LN-positive cases were re-classified according to the proposed staging system, 82 were N1 (26 %) and 60 were N2 (19 %). There was a significant correlation between proposed N-stage and lymphovascular invasion, perineural invasion, increased tumor size (each p < 0.001), and surgical margin positivity (p = 0.001). The median OS in LN-negative cases was significantly longer than that in LN-positive cases (107.5 vs. 32 months; p < 0.001). Patients with N1 and N2 disease had median survivals of 40 and 24.5 months, respectively (p < 0.0001). In addition, 1-, 3-, and 5-year survivals were 88, 76, 62 %, respectively, for N0; 90, 55, 31.5 %, respectively, for N1; and 68, 34, 30 %, respectively for N2 (p < 0.001). Even with multivariate modeling, the association between higher proposed N stage and shorter survival persisted (hazard ratio 1.6 for N1 and 1.9 for N2; p = 0.018). Conclusions Classification of nodal status in ampullary carcinomas based on the number of metastatic LNs has a significant prognostic value. A revised N-staging classification system should be incorporated into the TNM staging of ampullary cancers.

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© Society of Surgical Oncology 2015

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