Prognostic role of metastatic lymph node number and lymph node ratio in ampullary adenocarcinoma.



Fiammetta Soggiu1 MD, (FS)

Mikael H Sodergren1 PhD FRCS, (MHS)

Elephteria Kalaitzaki2 MSc, (EK)

Jeremy N Thompson1 MChir FRCS, (JNT)

Satvinder Mudan1 BSc MBBS MD FRCS, (SM)

Aamir Z Khan1 FRCS, (AZK)


1 Department of Academic Surgery, Royal Marsden Hospital National Health Foundation Trust, London, UK.

2 Research & Development, Royal Marsden Hospital National Health Foundation Trust, London,UK.


Corresponding author:

Fiammetta Soggiu

Department of Surgery Royal Marsden Hospital NHS Trust

203 Fulham Road, Chelsea, London SW3 6JJ, UK

Tel. 020 7352 8171 – Email:

Disclosures and funding source: We declare that we have no competing interests.




The role of the metastatic-to-resected lymph nodes ratio (LNR) and the metastatic lymph node number (LNN) in the staging of ampullary carcinoma (AC) is controversial. This retrospective study evaluates the impact on survival of LNN and LNR in resected AC.


One-hundred patients who underwent pancreaticoduodenectomy with standard lymphadenectomy for AC were categorized into N1 (1-2 metastatic LNs) or N2 (≥3 metastatic LNs) and into LNR ≤0.056 or LNR>0.056 groups. Kaplan-Meier survival curves and multivariate analysis of prognostic factors were assessed.


Median overall survival was 90, 36 and 36 for N0, N1 and N2 (p=0.014) and 85 and 35 months for LNR≤0.056 and LNR>0.056 (p=0.006). Median DFS was Not Reached (NR), 33 and 13 months for N0, N1 and N2 (p<0.001), and NR and 17 months for LNR≤0.056 LNR>0.056 (p<0.001). Independent prognostic factors were LNR>0.056 (HR 1.99; p=0.029), R1 margins (HR 2.4; p=0.042) and adjuvant chemotherapy (HR 1.76; p=0.044) for OS; LNN (HR 3.03 and 5.03 for N1 and N2; p=0.003), LNR>0.056 (HR 2.07; p=0.048), and tumor size ≥2cm (HR 2.73; p=0.018) for DFS. 


Both LNR>0.056 and increasing LNN (1-2 and ≥3) should be considered in the staging of AC, as they are independent predictors of worse prognosis.


Key words: Ampulla of Vater Adenocarcinoma; lymph node ratio; TNM staging; metastatic lymph node.


Multiselect Ultimate Query Plugin by InoPlugs Web Design Vienna | Webdesign Wien and Juwelier SchönmannMultiselect Ultimate Query Plugin by InoPlugs Web Design Vienna | Webdesign Wien and Juwelier Schönmann