Determinants Of Long-term Survival Of Ampullary Carcinoma After Pancreaticoduodenectomy

Background and Objective:Ampullary carcinoma is a rare type of tumor, which has a incidence of a disease of 0.063%--0.210%, ranking the second position in periampullary carcinoma. The only curative treatment for ampullary carcinoma is surgical resection, like pancreaticoduodenectomy (PD). The rate of surgical resection has reached 80%--95%, and the 5-year survival rate is mostly between 24%--60%. Multiple factors have effects on the long-tern survival after resection. We retrospectively investigated medical records of 78 patients with ampullary carcinoma which have accepted pancreaticoduodenectomy, in order to identify prognostic factors predicting survival after radical resection of ampullary carcinomaMethod:We collect medical records of 95 patients with ampullary carcinoma, which have accepted pancreaticoduodenectomy in Xiang-ya Hospital, Central South University, from Jan.1990 to Dec.2006.78 cases of them have followed up (rate of 82.1%). Statistical analysis was performed using the SPSS.15.0 software package. Survival data were analyzed according to the Kaplan-Meier method and the log-rank test was used to detect differences between individual groups. Multivariate analysis was performed using a Cox proportional hazards model with a backward stepwise selection procedure. The probability for entering the model was P<0.05.The factors that are kept in the Cox proportional hazards model as defined independent prognostic factor in patients with ampullary carcinoma after resection.Result:The median follow-up period was 72.2 months, the median survival time was 49 months with 3-and 5-year survival rates of 62.8% and 39.7%. By univariate analysis of potential prognostic factors, we find several factors have effect on the prognosis of ampullary-carcinoma radical cure. These factors are Intraoperative allogeneic red blood cell transfusion (P=0.008), histological type (P=0.003), tumor size (P=0.005), Pancreatic invasion (P=0.024), vascular invasion (P=0.016), tumor-positive resection margins (P<0.0001), the number of positive lymph nodes (P<0.0001) and the location of positive lymph nodes (P<0.0001). Multivariate analysis revealed that tumor-positive resection margins and the number of positive nodes lymph were independent prognostic factors.Conclusion:Multiple factors have effects on the prognosis of ampullary carcinoma after radical resection. Tumor-positive resection margins and the number of positive lymph nodes are independent prognostic factors in patients with ampullary carcinoma after resection. Moreover, the patients have poor prognosis if more than three lymph nodes were involved.