Table of Contents Author Guidelines Submit a Manuscript
HPB Surgery
Volume 2014, Article ID 890530, 10 pages
http://dx.doi.org/10.1155/2014/890530
Research Article

The Association between Survival and the Pathologic Features of Periampullary Tumors Varies over Time

1Department of Surgery, Loyola University Health Systems, 2160 S. First Avenue, Maywood, IL 60153, USA
2Department of Pathology, Loyola University Health Systems, 2160 S. First Avenue, Maywood, IL 60153, USA
3Stritch School of Medicine, Loyola University Medical Center, 2160 S. First Avenue, Maywood, IL 60153, USA
4Department of Preventive Medicine, Loyola University Medical Center, 2160 S. First Avenue, Maywood, IL 60153, USA

Received 19 February 2014; Accepted 15 June 2014; Published 1 July 2014

Academic Editor: Harald Schrem

Copyright © 2014 Jennifer K. Plichta et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Introduction. Several histopathologic features of periampullary tumors have been shown to be correlated with prognosis. We evaluated their association with mortality at multiple time points. Methods. A retrospective chart review identified 207 patients with periampullary adenocarcinomas who underwent pancreaticoduodenectomy between January 1, 2001 and December 31, 2009. Clinicopathologic features were assessed, and the data were analyzed using univariate and multivariate methods. Results. In univariate analysis, perineural invasion had a strong association with 1-year mortality (OR 3.03, CI 1.42–6.47), and one lymph node (LN) increase in the LN ratio (LNR) equated with a 5-fold increase in mortality. In contrast, LN status (OR 6.42, CI 3.32–12.41) and perineural invasion (OR 5.44, CI 2.81–10.52) had the strongest associations with mortality at 3 years. Using Cox proportional hazards, perineural invasion (HR 2.61, CI 1.77–3.85) and LN status (HR 2.69, CI 1.84–3.95) had robust associations with overall mortality. Recursive partitioning analysis identified LNR as the most important risk factor for mortality at 1 and 3 years. Conclusions. Overall mortality was closely related to the LNR within the first year, while longer follow-up periods demonstrated a stronger association with perineural invasion and overall LN status. Therefore, the current staging for periampullary tumors may need to be updated to include the LNR.