Department of Gastroenterology, Kyung Hee University College of Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea.
Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul National University Hospital, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Republic of Korea.
World J Surg Oncol. 2024 Nov 21;22(1):308. doi: 10.1186/s12957-024-03587-z.
BACKGROUND: Lymph node (LN) metastasis is an important prognostic factor in the ampulla of Vater (AoV) adenocarcinoma. Various LN parameters have been proposed, but their prognostic efficacy has not been compared in the same population. We aimed to evaluate the prognostic values of LN parameters in AoV adenocarcinoma patients who underwent surgical resection and adjuvant treatment based on the long-term follow-up data. METHODS: A total of 86 patients with surgically resected AoV adenocarcinoma followed by adjuvant treatment were analyzed. We evaluated the prognostic values of various LN parameters such as pathologic N stage, number of metastatic regional LN (LNN), LN ratio (LNR), and log odds of positive LNs (LODDS). Each LN parameter was separately analyzed using Cox regression models with the same confounders. RESULTS: The median follow-up period was 69.4 months, and the median overall survival (OS) was 114 months. The median number of dissected LNs is 15, with an interquartile range of 8 to 25. In the univariable analyses, all LN parameters showed significant prognostic efficacy for OS, disease-free survival (DFS), and distant metastasis-free survival (DMFS). In the multivariable Cox regression analyses, LNN ≥ 2 was a statistically significant prognostic factor for OS (hazard ratio (HR) 2.10, 95% confidence interval (CI), 1.11-3.97; p = 0.022), DFS (HR 2.51, 95% CI 1.28-4.93; p = 0.007), and DMFS (HR 2.74, 95% CI 1.39-5.41; p = 0.004). LNR showed significant prognostic performance for DFS (HR 2.35, 95% CI 1.23-4.50; p = 0.010), and DMFS (HR 2.26, 95% CI 1.17-4.35; p = 0.015). N stage showed significant prognostic performance in DFS (HR 1.55 for pN1; p = 0.243 and HR 4.31 for pN2; p = 0.003), DMFS (HR 1.46 for pN1; p = 0.323 and 4.59 for pN2; p = 0.002). LODDS and the presence of LN metastasis, did not demonstrate significant prognostic value across survival outcomes. CONCLUSIONS: LN parameters showed good long-term predictive performance in AoV adenocarcinoma patients treated with curative resection and adjuvant treatments. Among LN parameters, LNN ≥ 2 showed better prognostic value than others. Further large-scale studies are needed to validate the clinical usefulness of various LN parameters.
背景：淋巴结（LN）转移是壶腹（AoV）腺癌的一个重要预后因素。已经提出了各种 LN 参数，但尚未在同一人群中比较它们的预后效果。我们旨在评估基于长期随访数据，在接受手术切除和辅助治疗的 AoV 腺癌患者中 LN 参数的预后价值。
方法：共分析了 86 例接受手术切除并接受辅助治疗的 AoV 腺癌患者。我们评估了各种 LN 参数的预后价值，例如病理 N 期、转移性区域 LN（LNN）数量、LN 比（LNR）和阳性 LN 的对数优势（LODDS）。使用相同的混杂因素，分别使用 Cox 回归模型对每个 LN 参数进行分析。
结果：中位随访时间为 69.4 个月，中位总生存期（OS）为 114 个月。中位解剖 LN 数量为 15，四分位间距为 8 至 25。在单变量分析中，所有 LN 参数均对 OS、无病生存期（DFS）和远处转移无病生存期（DMFS）具有显著的预后作用。在多变量 Cox 回归分析中，LNN≥2 是 OS（风险比（HR）2.10，95%置信区间（CI）1.11-3.97；p=0.022）、DFS（HR 2.51，95%CI 1.28-4.93；p=0.007）和 DMFS（HR 2.74，95%CI 1.39-5.41；p=0.004）的统计学显著预后因素。LNR 对 DFS（HR 2.35，95%CI 1.23-4.50；p=0.009）和 DMFS（HR 2.26，95%CI 1.17-4.35；p=0.015）具有显著的预后作用。N 期在 DFS（HR 1.55 为 pN1；p=0.243 和 HR 4.31 为 pN2；p=0.003）和 DMFS（HR 1.46 为 pN1；p=0.323 和 HR 4.59 为 pN2；p=0.002）中显示出显著的预后作用。LODDS 和 LN 转移的存在在生存结果方面没有显示出显著的预后价值。
结论：LN 参数在接受根治性切除和辅助治疗的 AoV 腺癌患者中显示出良好的长期预测性能。在 LN 参数中，LNN≥2 显示出比其他参数更好的预后价值。需要进一步的大规模研究来验证各种 LN 参数的临床实用性。
J Hepatobiliary Pancreat Sci. 2020-10
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