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Prognostic Factors of Long-term Survival Following Radical Resection for Ampullary Carcinoma

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Abstract

Background

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.

Methods

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.

Results

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).

Conclusion

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.

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Acknowledgments

We thank Stela Maris de Jezus Castro and Sidia Jacques for statistical analysis support.

Funding

This work was supported by CNPq/Rede Genoprot (Grant #559814/2009-7) and Research and Events Incentive Fund (Fundo de Incentivo à Pesquisa e Eventos – FIPE, GPPG Grant #09-287) of Hospital de Clínicas de Porto Alegre (HCPA).

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Author notes

  1. Daniel Weiss Vilhordo and Cleandra Gregório contributed equally to this work.

Authors and Affiliations

  1. Postgraduate Program in Medicine: Surgical Sciences, Medical School of Universidade Federal do Rio Grande do Sul – (FAMED-UFRGS), Porto Alegre, RS, Brazil

    Daniel Weiss Vilhordo & Alessandro Bersch Osvaldt

  2. Postgraduate Program in Genetics and Molecular Biology, Medical School of Universidade Federal do Rio Grande do Sul – (FAMED-UFRGS), Porto Alegre, RS, Brazil

    Cleandra Gregório

  3. Service of Digestive Surgery, Hospital de Clínicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, 90035-903, Brazil

    Dirceu Felipe Valentini Jr

  4. Service of Pathology, Hospital de Clínicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil

    Maria Isabel Albano Edelweiss & Diego Mendonça Uchoa

  5. Service of Digestive Surgery, Group for Biliary Tract and Pancreas, Hospital de Clínicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil

    Alessandro Bersch Osvaldt

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  1. Daniel Weiss Vilhordo
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Vilhordo, D.W., Gregório, C., Valentini, D.F. et al. Prognostic Factors of Long-term Survival Following Radical Resection for Ampullary Carcinoma. J Gastrointest Canc 52, 872–881 (2021). https://doi.org/10.1007/s12029-020-00479-9

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