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• W3208473530 abstract "Purpose: Ampullary adenocarcinoma (AAC) is a rare malignancy with extensive morphological heterogeneity. Variable results have been reported regarding the predictive value of lymph node ratio (LNR) on survival in patients with resected AAC. The aim of this study was to investigate the prognostic predictive value of LNR adjusted for factors influencing survival in patients with resected AAC. Methods: This retrospective international multicenter cohort study included all patients who underwent pancreatoduodenectomy for AAC (2006-2020). Patients who underwent palliative procedures or local excision of AAC were excluded, as were patients with an R2 resection, distant metastasis, or 30-day postoperative mortality. Overall survival(OS) was assessed using the Kaplan-Meier method and log-rank tests. Cox proportional hazard models were performed to identify independent predictors of OS. Optimal cut-off for LNR was determined calculating the Youden’s index and logrank test. Results: Overall, 1230 patients after pancreatoduodenectomy for AAC were included. Histopathologic subtype was documented in 907 patients (73.7%), of whom 369 had intestinal subtype (40.7%), 477 pancreaticobiliary subtype (52.6%), and 61 a mixed subtype (6.7%). Median survival was not reached for the intestinal subtype. For the pancreatobiliary subtype and mixed subtype, median survival was 60 (42-77), and 76 (35-116) months, respectively(Figure1). The optimal cut-off for the LNR was 0.10. Age, tumor size, resection margin, T3/4 stage, poor tumor differentiation, and LNR were independent predictors of survival (Table 1). Conclusion: This study shows the importance of LNR for prognosis in patients with all histopathological subtypes of resected AAC and an optimal cut-off point for the LNR of 0.10.Table 1Multivariable Analysis identifying Risk Factors Associated With Overall Survival According to the Cox Proportional Hazard ModelHazard Ratio[95% CI]P ValueAge1.028(1.017-1.040)<0.001Tumor Size1.011(1.003-1.019)0.006Resection margin1.295(1.012-1.655)0.040Perineural invasion1.036(0.820-1.310)0.765Lymphovascular invasion1.193(0.972-1.536)1.171T stage 3/41.614(1.241-2.097)<0.001Tumor differentiation1.297(1.058-1.589)0.012LNR LNR 0-0.1 LNR > 0.11.4333.289(1.020-2.012)(2.485-4.401)0.038<0.001 Open table in a new tab" @default.
• W3208473530 created "2021-11-08" @default.
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• W3208473530 date "2021-01-01" @default.
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• W3208473530 title "Impact of Lymph Node Ratio on Survival in the Histopathological Subtypes of Resected Ampullary Cancer: A Retrospective International Multicenter Cohort Study" @default.
• W3208473530 doi "https://doi.org/10.1016/j.hpb.2021.08.152" @default.
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