Novel Prognostic Factors in Tumors of the Ampulla of Vater: The Lymph Node Ratio and Hemoglobin Albumin Lymphocyte Platelet (HALP) Score

Yüce E., Fidan E.

EUROASIAN JOURNAL OF MEDICAL INVESTİGATION, vol.7, no.3, pp.224-230, 2023 (Peer-Reviewed Journal)


Objectives: Tumors of the ampulla-of-Vater are rare, and accurate prognosis is essential. We examined the significance of the hemoglobin-albumin-lymphocyte-platelet (HALP) score and lymph-node-ratio (LNR). Methods: Thirty-four patients in 2003-2018 were examined retrospectively. Results: Twelve women and 22 men were enrolled. Tumors were ≤2 cm in 11 (32.4%) and >2 cm in 17 (50%). Seven (38.9%) were in the LNR 1 (<0.1) group and 11 (61.1%) in the LNR 2 (≥0.1) group. Fifteen (62.5%) of the 24 operated patients received adjuvant-therapy, with recurrence in 12 (50%). Overall survival (OS) was significantly shorter with carcinoembryonic-antigen (CEA) elevation at diagnosis compared to normal CEA (mean OS 27.1 vs. 89.8 months, p:0.029). OS was longer in stages 1–2 than 3–4 (mean OS 100.5 vs. 46.7 months, p:0.03), but shorter in patients with tumors >2 cm compared to tumors ≤2 cm (mean OS 53.2 vs. 90 months, p:0.059). No significant difference in OS emerged between the LNR 1 and 2 groups (114.8 vs. 82.9 months). No significant difference emerged in OS, disease-free, or progressionfree-survival for HALP. Conclusion: Pre-operative CEA elevation, Stages 3–4, and tumor sizes exceeding 2 cm result in poor prognosis. The LNR and HALP have no effect on prognosis. Keywords: Tumors of the ampulla of Vater, hemoglobin-albumin-lymphocyte-platelet (HALP) score, lymph node ratio (LNR