{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,14]],"date-time":"2025-11-14T10:35:28Z","timestamp":1763116528544,"version":"3.45.0"},"reference-count":33,"publisher":"MDPI AG","issue":"22","license":[{"start":{"date-parts":[[2025,11,14]],"date-time":"2025-11-14T00:00:00Z","timestamp":1763078400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Background: Morphological subclassification may refine prognosis after curative pancreaticoduodenectomy (PD) for periampullary cancers. Methods: We conducted a single-center retrospective cohort including 120 consecutive PDs performed between 2005 and 2022. Tumors were classified as intestinal (INT), pancreatobiliary (PB), or pancreatic ductal adenocarcinoma (PAN). Clinicopathologic variables included T stage, margin status, lymphovascular and perineural invasion, and lymph node ratio (LNR; cutoff 0.154 determined by ROC\/Youden). Overall survival (OS) was the primary endpoint and was analyzed using Kaplan\u2013Meier with log-rank tests and multivariable Cox regression. Results: INT tumors were associated with earlier T stage, fewer adverse histologic features, and higher R0 resection rates compared with PB and PAN. In multivariable analysis, mortality risk was higher for PB (HR 4.41; 95% CI 1.25\u201315.53) and PAN (HR 13.96; 95% CI 3.99\u201348.75) relative to INT. LNR \u2265 0.154 independently predicted worse OS (HR 1.93; 95% CI 1.11\u20133.35). Mean OS was 108.8 months for INT, 62.0 months for PB, and 22.7 months for PAN (log-rank p &lt; 0.001). Conclusions: Morphological subtype and LNR are independent prognostic factors after PD for periampullary malignancies. Integrating morphology and nodal burden into risk models may improve postoperative stratification and guide adjuvant therapy.<\/jats:p>","DOI":"10.3390\/cancers17223652","type":"journal-article","created":{"date-parts":[[2025,11,14]],"date-time":"2025-11-14T10:07:03Z","timestamp":1763114823000},"page":"3652","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Evaluating the Role of Morphological Subtypes in the Classification of Periampullary Adenocarcinomas"],"prefix":"10.3390","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8238-5095","authenticated-orcid":false,"given":"Jo\u00e3o Bernardo","family":"Sancio","sequence":"first","affiliation":[{"name":"Department of Surgery, School of Medicine, Federal University of Minas Gerais, Belo Horizonte 30130-100, MG, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-5424-3533","authenticated-orcid":false,"given":"Raul Val\u00e9rio","family":"Ponte","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Institute Dr. Jos\u00e9 Frota (IJF), Fortaleza 60025-061, CE, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3692-290X","authenticated-orcid":false,"given":"Henrique Ara\u00fajo","family":"Lima","sequence":"additional","affiliation":[{"name":"Department of Surgery, School of Medicine, Federal University of Minas Gerais, Belo Horizonte 30130-100, MG, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Augusto Henrique","family":"Marchiodi","sequence":"additional","affiliation":[{"name":"Department of Surgery, School of Medicine, Federal University of Minas Gerais, Belo Horizonte 30130-100, MG, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuiti Pedro Henrique","family":"Yamashita","sequence":"additional","affiliation":[{"name":"Department of Surgery, School of Medicine, Federal University of Minas Gerais, Belo Horizonte 30130-100, MG, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8647-130X","authenticated-orcid":false,"given":"Leonardo do Prado","family":"Lima","sequence":"additional","affiliation":[{"name":"Department of Surgery, School of Medicine, Federal University of Minas Gerais, Belo Horizonte 30130-100, MG, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2777-3268","authenticated-orcid":false,"given":"Priscila Ferreira de Lima e","family":"Souza","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, School of Medicine, Federal University of Cear\u00e1, Fortaleza 60020-181, CE, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6157-6511","authenticated-orcid":false,"given":"Eduardo Paulino","family":"Junior","sequence":"additional","affiliation":[{"name":"Department of Clinical Pathology, School of Medicine, Federal University of Minas Gerais, Belo Horizonte 30130-100, MG, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4430-8889","authenticated-orcid":false,"given":"Marcelo Dias","family":"Sanches","sequence":"additional","affiliation":[{"name":"Department of Surgery, School of Medicine, Federal University of Minas Gerais, Belo Horizonte 30130-100, MG, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4400-0427","authenticated-orcid":false,"given":"Vivian","family":"Resende","sequence":"additional","affiliation":[{"name":"Department of Surgery, School of Medicine, Federal University of Minas Gerais, Belo Horizonte 30130-100, MG, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,11,14]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"543","DOI":"10.1016\/S0039-6109(05)70142-0","article-title":"Periampullary cancers: Are there differences?","volume":"81","author":"Sarmiento","year":"2001","journal-title":"Surg. 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