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

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.

Proposed new staging system for ampulla of Vater cancer with greater discriminatory ability: multinational study from eastern and western centers

“…analyzed 1,057 patients with surgically resected ampullary adenocarcinoma, in each of whom ≥12 LNs were examined, and found that survival was significantly poorer in patients with ≥3 than with 1–2 positive LNs . These cutoff points of 0, 1–2, and ≥3 positive LNs have been validated as prognostic factor of survival in another study .…”

“…In addition, the 7 th AJCC staging system for AoV cancer has defined N0 as no regional lymph node (LN) metastasis and N1 as regional LN metastasis, whereas it defines N stage in most gastrointestinal tract cancers based on the number of positive LNs . Several studies have shown that LN metastasis is one of the most powerful prognostic factors in patients with AoV cancer and have attempted to define N stage based on various cutoffs for positive LNs . However, data are limited, precluding the combination of these heterogeneous results and the validation of current staging system for more accurate diagnosis and prognosis.…”

Preoperative Endoscopic Biliary Drainage May Negatively Impact Survival Following Pancreatoduodenectomy for Ampullary Cancer

“…The published data show 1-year survival after pancreatoduodenectomy for cancer of the papilla of Vater to be around 80%, 3-year survival around 60-70%, and 5-year survival around 50% [21] . Moreover, some series with R0 resection in T1 patients reported the 5-year survival to be 100% [8] .…”

Carcinoma of Ampulla of Vater: Carcinogenesis and Immunophenotypic Evaluation

“…Several studies have associated clinical and biological behavior of the ampullary carcinoma intestinal tumors [1,[23][24][25][26][27][28][29][30]. Among the reasons are: the highest frequency of intestinal type in most studies (Table 1), the process of carcinogenesis by chromosomal instability ("adenomacarcinoma" sequence), as is observed in colorectal cancers.…”