Ann Hepatobiliary Pancreat Surg.  2020 Nov;24(4):484-495. 10.14701/ahbps.2020.24.4.484.

Impact of lymph node staging systems in predicting outcome in patients with ampullary cancer

• Saluja SS
• Mishra PK
• Kiran S
• Shah HJ
• Chandrasekar S
• Nayeem M
• Sharma A
• Varshney VK

• KMID: 2508858
• DOI: http://doi.org/10.14701/ahbps.2020.24.4.484

Abstract

Backgrounds/Aims
Lymph node (LN) metastasis though, is a poor prognostic factor for ampullary carcinoma (APC), the impact of Lymph node ratio (LNR) and Logarithm odds of positive lymph node (LODDS) in the long-term survival remains controversial. We evaluated the factors affecting the long-term outcome in APC patients with emphasis on LNR and LODDS.
Methods
The prospectively collected data of 198 patients who underwent pancreatoduodenectomy for APC was analyzed after excluding 12 patients for various reasons. Factors affecting Disease specific survival (DSS) and Recurrence free survival (RFS) were analyzed with special reference to LN positivity, LNR and LODDS.
Results
Out of 186, 117 (62.9%) patients were alive at a median follow-up of 39.5 months and 72 (38.7%) developed recurrence. The overall 5-year DSS was 59.3% & RFS 54.9%. Univariate analysis showed T-stage, tumor differentiation, perineural invasion, LN positivity, LNR and LODDS was significantly affected DSS and RFS. On multivariate analysis, perineural invasion, LN positivity, LNR and LODDS lost its significance for DSS and RFS. AUC for prediction of DSS and RFS for LNR was 0.654 (p<0.001) & 0.629 (p=0.003) respectively and for LODDS, it was 0.697 (p<0.001) & 0.677 (p=0.001) respectively. Sensitivity and specificity of LNR (0.1) for DSS were 37.7% & 83.8% and for RFS were 36.1% & 83.3%; for LODDS (−1.00), sensitivity and specificity for DSS was 62.3% and 67.5% and for RFS it was 59.7% and 66.7% respectively.
Conclusions
LNR and LODDS although independently seem to affect the RFS and DSS, albeit have a low sensitivity and specificity in predicting DSS and RFS.

Keyword

Periampullary; Pancreatoduodenectomy; Lymph node ratio; LODDS; Survival; Long term

Figure

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  Fig. 1 Patient profile with inclusion and exclusion criteria.

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  Fig. 2 (A and B) Depicting significantly better disease specific survival (DSS) in patients with T1/T2 stage and well differentiated ampullary tumors; (C-G) DSS is worse with patients with Perineural invasion, lymph node ratio (LNR) of >0.1, LODDS cut off at 4 & 5, lymph node positive disease, and >3 L.N positive, however not statistically significant; (H) ROC curves showing DSS prediction by LNR. AUC was 0.654 for DSS with p-value of <0.001; (I) ROC curves showing DSS prediction by LODDS. AUC was 0.697 for DSS with p-value of <0.001.

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  Fig. 3 (A and B) Depicting significantly lower recurrence free survival (RFS) in patients with T1/T2 stage and well differentiated ampullary tumor; (C-G) RFS is worse in patients with Perineural invasion, lymph node ration of >0.1, LODDS cut off at 4 & 5, lymph node positivity, and >3 L.N. positive, however not statistically significant; (H) ROC curves showing RFS prediction by LNR. AUC was 0.629 for RFS with p-value of 0.003; (I) ROC curves showing RFS prediction by LODDS. AUC was 0.677 for RFS with p-value of <0.001.

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