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J Hepatobiliary Pancreat Sci. 2017 Aug;24(8):475-484. doi: 10.1002/jhbp.486. Epub 2017 Aug 4.

Proposed new staging system for ampulla of Vater cancer with greater discriminatory ability: multinational study from eastern and western centers.

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Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.
Department of Mathematics and Statistics, Sejong University College of Natural Sciences, Seoul, Korea.
Department of Statistics, Seoul National University College of Natural Sciences, Seoul, Korea.



We built a multinational retrospective database of patients with ampulla of Vater cancer to develop a reliable new staging system.


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.


The 5-year overall survival (OS) rates of patients staged according to the 7th 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).


This new staging system has better discriminatory ability in stratifying 5-year OS rates based on a large multinational database.


Ampulla of Vater; Cancer staging; Neoplasm staging

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