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전이 림프절 비율 (LNR)과 전이 림프절의 개수 (MLN)에 따른 전체 생존율 (Overall survival)과 무국소 재발 생존율 (Locoregional failure-free survival)​

Abstract

PURPOSE:

Attempts have been made to revise the nodal stage due to simplicity of current N staging system in ampullary adenocarcinoma. However, because of the disease rarity, there have only been a few studies assessing the prognostic impact of lymph node (LN) parameters.

METHODS:

We retrospectively analyzed 120 patients who underwent radical resection followed by adjuvant chemoradiotherapy for ampullary adenocarcinoma. The effect of LN parameters (number of total harvest LNs, number of metastatic LN (MLN), lymph node ratio (LNR), and log odds of positive LNs (LODDS)) on overall survival (OS), locoregional relapse-free survival (LRFS) and distant metastasis-free survival were evaluated. Cutoff points of MLN, LNR and LODDs were determined using maximal χ2 method.

RESULTS:

Fifty-seven patients (48%) were staged as pN1 and their survival was not significantly decreased compared with pN0 patients. There was also no significant difference between patients with MLN 0 vs. 1. In univariate analyses, MLN (0-1 vs. ≥2), LNR (≤17% vs. >17%) and perineural invasion were common prognosticators for OS and LRFS. Distant metastasis-free survival was not influenced by LN status. In addition, multivariate analysis revealed that among the LN parameters, LNR was able to independently predict both OS and LRFS.

CONCLUSIONS:

LNR performs better than other LN related parameters for predicting survival. After radical resection followed by adjuvant treatment, survival of patients with one positive LN does not seem to differ from patients without LN metastasis.

Author information

Kwon J1, Kim K2, Chie EK3, Kim BH3, Jang JY4, Kim SW4, Oh DY5, Bang YJ5.

1 Department of Radiation Oncology, Seoul National University College of Medicine, Daehak-ro 101, Jongno-gu, Seoul, South Korea; Department of Radiation Oncology, Chungnam National University Hospital, Munhwaro 282, Jungku, Daejeon, South Korea.

2 Department of Radiation Oncology, Ewha Womans University School of Medicine, Anyangcheon-ro, Yangcheon-gu, Seoul, South Korea. Electronic address: kyubokim.ro@gmail.com.

3 Department of Radiation Oncology, Seoul National University College of Medicine, Daehak-ro 101, Jongno-gu, Seoul, South Korea.

4 Department of Surgery, Seoul National University College of Medicine, Daehak-ro 101, Jongno-gu, Seoul, South Korea.

5 Department of Internal Medicine, Seoul National University College of Medicine, Daehak-ro 101, Jongno-gu, Seoul, South Korea.