Role of systemic inflammation in predicting the prognosis of ampulla of Vater carcinoma

Abstract

Background: Ampulla of Vater carcinoma (AVC) is known to have better prognosis than other periampullary cancers that need pancreaticoduodenectomy for cure. However, up to 60% of patients who underwent curative resection develop recurrence, and the disease progresses rapidly in many patients. Inflammatory factors are known to be prognostic indicators related to poor overall survival (OS) in patients with other gastrointestinal cancers. This retrospective review aimed to assess the prognostic significance of the preoperative neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and Glasgow Prognostic Score (GPS) in patients who underwent curative resection for AVC.

Method: We retrospectively reviewed and abstracted data from the medical records of 169 patients who underwent surgical resection for AVC from January 2009 through December 2013. We investigated the association between the preoperative NLR, PLR, and GPS and disease-free survival (DFS) and OS.

Results: In multivariable analysis, both high NLR and PLR were not associated with poor DFS but were significantly related to poor OS (NLR: hazard ratio [HR] 1.916, 95% confidence interval [CI] 1.181-3.108, p = 0.008; PLR: HR 1.758, 95% CI 1.071-2.886, p = 0.026). GPS was not a significant prognostic factor for either DFS or OS in both univariable and multivariable analyses. Young age was not related to OS but was significantly associated with poor DFS in both univariable and multivariable analyses (HR 0.356, 95% CI 0.163-0.778, p = 0.010).

Conclusion: As systemic inflammatory markers, high preoperative NLR and PLR were related to poor OS in patients with AVC with curative resection.

Keywords: Ampulla of Vater carcinoma; Glasgow prognostic score; Neutrophil-to-lymphocyte ratio; Platelet-to-lymphocyte ratio; Prognosis; Resection.