Development of a Prognostic Model That Predicts Survival After Pancreaticoduodenectomy for Ampullary Cancer.

13 Sep 2017

Objectives: The aims of this study were to i) identify independent predictors of survival following pancreaticoduodenectomy for ampullary cancer and ii) develop a prognostic model of survival. Methods: Data were analysed retrospectively on 110 consecutive patients who underwent pancreaticoduodenectomy between 2002-2013. Subjects were categorised into 3 nodal sub-groups as per the recently proposed nodal sub-classification: N0 (node negative), N1 (1-2 metastatic nodes) or N2 (≥3 metastatic nodes). Clinicopathological features and overall survival were compared by Kaplan Meier and Cox regression analyses. Results: The overall 1-, 3- and 5-year survival rates were 79.8%, 42.2% and 34.9% respectively. The overall 1-, 3- and 5-year survival rates for the N0 group were 85.2%, 71.9% and 67.4% respectively. The 1-,3-,5-year survival rates for the N1 and N2 subgroups were 84.6%, 58.4%, 56.4% and 80.2%, 38.8% and 8.0% respectively (log rank, p<0.0001). After performing a multivariate Cox regression analysis vascular invasion and lymph node ratio were the only independent predictors of survival. Hence a prediction model of survival was constructed based on those 2 variables. Conclusion: Using data from a carefully selected cohort of patients we created a pilot prognostic model of post-resectional survival. The proposed model may help clinicians to guide treatments in the adjuvant setting.