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

Annals of Surgical Oncology
Serdar BalciVolkan Adsay

Abstract

Current nodal staging (N-staging) of ampullary 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. 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. Clinicopathological features and overall survival (OS) of the three groups were compared. 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...Continue Reading

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Citations

Oct 1, 2016·Pathology, Research and Practice·Iraklis PerysinakisGregory Kouraklis
Jan 6, 2017·Archives of Pathology & Laboratory Medicine·Michelle D ReidN Volkan Adsay
Mar 17, 2018·Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract·Ibrahim NassourSam C Wang
Jan 30, 2019·Pathology Oncology Research : POR·Cihan AgalarIbrahim Astarcioglu
Apr 8, 2020·Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract·Xi-Tai HuangXiao-Yu Yin
Mar 3, 2021·Annals of Hepato-biliary-pancreatic Surgery·Jeong Woo LeeWan Bae Kim
Aug 11, 2020·Surgical Pathology Clinics·Yue Xue, Michelle D Reid
Aug 22, 2021·Hepatobiliary & Pancreatic Diseases International : HBPD INT·Shi-Jie WangYan-Ming Zhou

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