TY - JOUR
T1 - A High Positive Lymph Node Ratio is Associated with Distant Recurrence after Surgical Resection of Ampullary Carcinoma
AU - Roland, Christina L.
AU - Katz, Matthew H.G.
AU - Gonzalez, Graciela M.N.
AU - Pisters, Peter W.T.
AU - Vauthey, Jean Nicolas
AU - Wolff, Robert A.
AU - Crane, Christopher H.
AU - Lee, Jeffrey E.
AU - Fleming, Jason B.
N1 - Funding Information:
Acknowledgments This research has been supported by the various donor funds for Pancreatic Cancer Research at the University of Texas M.D. Anderson Cancer Center and the NIH through the M.D. Anderson Cancer Center Support Grant CA0166672 and the Ruth L. Kirschstein National Research Service Award T32CA009599-23.
PY - 2012/11
Y1 - 2012/11
N2 - 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.
AB - 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.
KW - Ampullary carcinoma
KW - Lymph node ratio
KW - Recurrence
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U2 - 10.1007/s11605-012-2015-2
DO - 10.1007/s11605-012-2015-2
M3 - Article
C2 - 22914983
AN - SCOPUS:84869135558
SN - 1091-255X
VL - 16
SP - 2056
EP - 2063
JO - Journal of Gastrointestinal Surgery
JF - Journal of Gastrointestinal Surgery
IS - 11
ER -