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Proposed new staging system for ampulla of Vater cancer with greater discriminatory ability: multinational study from eastern and western centers
Author(s) -
He Jin,
Kim Jae Ri,
Lee Seung Yeoun,
Oh Jinseok,
Park Taesung,
Kang Mee Joo,
Kwon Wooil,
Kim Hongbeom,
Kim SunWhe,
Cameron John L.,
Wolfgang Christopher L.,
Jang JinYoung
Publication year - 2017
Publication title -
journal of hepato‐biliary‐pancreatic sciences
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.63
H-Index - 60
eISSN - 1868-6982
pISSN - 1868-6974
DOI - 10.1002/jhbp.486
Subject(s) - ampulla of vater , medicine , stage (stratigraphy) , multinational corporation , cancer , gastroenterology , cancer staging , t stage , surgery , general surgery , carcinoma , biology , paleontology , political science , law
Background We built a multinational retrospective database of patients with ampulla of Vater cancer to develop a reliable new staging system. Method This study included 841 patients with ampulla of Vater cancer after curative surgery at Seoul National University Hospital ( n = 440) and Johns Hopkins University medical institutions ( n = 401) between 1985 and 2013. Results The 5‐year overall survival ( OS ) rates of patients staged according to the 7 th American Joint Committee on Cancer staging system were 80.3%, 60.9%, 58.1%, 36.6%, 17.9%, and 25.0% for Stages IA ( n = 140), IB ( n = 194), IIA ( n = 115), IIB ( n = 348), III ( n = 33), and IV ( n = 4), respectively. Five‐year OS rates were similar in patients with Stage IB (T2N0M0) and IIA (T3N0M0) tumors ( P = 0.556), but differed significantly between other pairs of groups. The number of positive lymph nodes ( PLN ) enhanced prognosis when stratified as 0, 1–2 and ≥3 ( P < 0.001). The revised staging system consisted of Stages I (T1, PLN 0), IIA (T2–T3, PLN 0), IIB (T1–T3, PLN 1–2), III ( PLN ≥3 or any T4), and IV (any M1), with 5‐year OS rates differing significantly in each pair of groups, including Stages I and IIA ( P < 0.001). Conclusion This new staging system has better discriminatory ability in stratifying 5‐year OS rates based on a large multinational database.