Postgraduate Program in Medicine: Surgical Sciences, Medical School of Universidade Federal do Rio Grande do Sul - (FAMED-UFRGS), Porto Alegre, RS, Brazil.
Postgraduate Program in Genetics and Molecular Biology, Medical School of Universidade Federal do Rio Grande do Sul - (FAMED-UFRGS), Porto Alegre, RS, Brazil.
J Gastrointest Cancer. 2021 Sep;52(3):872-881. doi: 10.1007/s12029-020-00479-9.
The incidence of adenocarcinoma of the ampulla of Vater has been increasing over the past years. Nevertheless, it is still a rare disease and the prognostic factors predicting long-term survival are not sufficiently clarified. This study aims to evaluate the association between histopathological characteristics and long-term survival of patients with ampullary cancer after curative resection, as well as the efficiency of immunohistochemical expression of CK7, CK20, and CDX2 to distinguish the histopathological (intestinal or pancreaticobiliary) patterns.
Demographic, histopathological data, pTNM stage, and immunohistochemical expression patterns were collected from 65 patients with adenocarcinoma of the ampulla of Vater. Five and 10-year overall and disease-free survival rates after curative resection were determined.
Of the 65 patients with ampullary carcinoma, 47 (72%) underwent radical resection. The 5- and 10-year overall survival rate was 46% and 37%, respectively. Our results demonstrate that the main prognostic factors were the presence and number of lymph node metastases, lymph node ratio (LNR), differentiation grade, and lymphovascular invasion. After multivariate analysis, only lymph node ratio ≥ 20% remained an independent prognostic factor of survival (HR: 2.63 95% CI: 1.05-6.61; p = 0.039).
Here, we demonstrated more evidence that the lymph node metastases are associated with poor prognosis in ampullary carcinoma. Particularly, the relation between the number of metastatic lymph nodes and the number of harvested lymph node (LNR) should be considered a major prognostic factor.
近年来， Vater 壶腹腺癌的发病率一直在上升。然而，它仍然是一种罕见的疾病，预测长期生存的预后因素尚不清楚。本研究旨在评估根治性切除术后壶腹癌患者的组织病理学特征与长期生存之间的关系，以及 CK7、CK20 和 CDX2 的免疫组织化学表达区分组织病理学（肠或胰胆管）模式的效率。
收集 65 例 Vater 壶腹腺癌患者的人口统计学、组织病理学数据、pTNM 分期和免疫组织化学表达模式。确定根治性切除术后的 5 年和 10 年总生存率和无病生存率。
在 65 例壶腹癌患者中，47 例（72%）接受了根治性切除术。5 年和 10 年的总生存率分别为 46%和 37%。我们的结果表明，主要的预后因素是淋巴结转移的存在和数量、淋巴结比率（LNR）、分化程度和血管淋巴管侵犯。多因素分析后，只有淋巴结比率≥20%仍然是生存的独立预后因素（HR：2.63 95%CI：1.05-6.61；p=0.039）。
我们的研究结果进一步证明了淋巴结转移与壶腹癌预后不良相关。特别是，转移淋巴结的数量与采集的淋巴结数量（LNR）之间的关系应被视为主要的预后因素。
