A Comprehensive Assessment of Accurate Lymph Node Staging and Preoperative Detection in Resected Pancreatic Cancer

Masuda, Toshiro; Dann, Amanda M.; Elliott, Irmina A.; Baba, Hideo; Kim, Stephen; Sedarat, Alireza; Muthusamy, V. Raman; Girgis, Mark D.; Hines, Oscar J.; Reber, Howard A.; Donahue, Timothy R.

doi:10.1007/s11605-017-3607-7

Cited by 25 publications

(31 citation statements)

References 35 publications

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“…In a previous study using the Surveillance, Epidemiology, and End Results (SEER) database, the median number of examined LNs in patients with resected pancreatic cancer was 7 (range, 0-90), and at least 12 resected lymph nodes were required to adequately evaluate LN metastasis [14]. It is also known that the number of examined LNs in pancreatic cancer can be different according to the type of surgery [4, 6]. In this study, the number of dissected LNs was more than 12 regardless of the surgery type.…”

Section: Discussionmentioning

confidence: 99%

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Lymph node ratio as valuable predictor in pancreatic cancer treated with R0 resection and adjuvant treatment

et al. 2019

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Background Lymph-node (LN) metastasis is an important prognostic factor in resected pancreatic cancer. In this study, the prognostic value of American Joint Committee on Cancer (AJCC) 8th edition N stage, lymph-node ratio (LNR), and log odds of positive lymph nodes (LODDS) in resected pancreatic cancer was investigated. Methods Between January 2005 and December 2017, there were 351 patients with pancreatic cancer treated with R0 resection and adjuvant therapy at Seoul National University Hospital. Relationships between the three LN parameters and overall survival (OS) and recurrence-free survival (RFS) were evaluated using a log-rank test and Cox proportional hazard regression model. Each multivariate-adjusted LN parameter was internally validated by bootstrap-corrected Harrell’s C-index. Results The mean duration from surgery to adjuvant therapy was 47.6 ± 17.4 days. In total, the median OS and RFS was 31.7 (95% CI, 27.2-37.2) and 15.4 (95% CI, 13.5-17.7) months. The three LN classification systems were significantly correlated with OS and RFS in log-rank tests and multivariate-adjusted models (all p < 0.05). When internally validated, LNR showed the highest discrimination ability in predicting OS and RFS (each C–index = 0.65). LNR also showed the highest C-index in subgroup analysis, classified by adjuvant therapy modality. LNR and the AJCC 8th edition LN classification system were significantly associated with loco-regional recurrence (p = 0.026 and p = 0.027, respectively). Conclusions LNR, which showed the best prognostic performance and significant relationship with loco-regional recurrence, can help further stratify the patients and establish an active treatment plan.

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Section: Discussionmentioning

confidence: 99%

“…In the AJCC 7th edition, the staging system defined all regional LN metastases as N1. The 8th edition was revised to further evaluate the LN grade based on the number of metastatic nodes [4].…”

Section: Introductionmentioning

confidence: 99%

Lymph node ratio as valuable predictor in pancreatic cancer treated with R0 resection and adjuvant treatment

et al. 2019

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“…The assessment of LN metastasis in pancreatic cancer is accomplished by the tumor node metastasis (TNM) staging system. The seventh edition of the American Joint Committee on Cancer (AJCC) classification system defined N1 as the presence of any number of positive regional LNs, whereas in the eighth edition of AJCC nodal classification was further categorized on the number of positive nodes [6].…”

Section: Introductionmentioning

confidence: 99%

Lymph Node Ratio as a Prognostic Marker in Pancreatic Cancer Survival: A Systematic Review and Meta-Analysis

Karjol

Chandranath

Jonnada

et al. 2020

Cureus

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The lymph node ratio (LNR) is defined as the ratio of number of positive lymph nodes to the total number of lymph nodes harvested during surgery. The objective of this article is to investigate the efficacy of LNR as a prognostic indicator of survival in pancreatic cancer patients who have undergone surgery by meta-analysis. Methods A systematic database search was performed in MEDLINE, Embase, and Google Scholar for relevant studies that reported LNR in pancreatic cancer. Two authors independently screened the relevant articles for selection and to extract data. All studies published in English up to April 2020 were obtained, and a total of 17,128 node-positive patients in 14 studies were included in this meta-analysis. RevMan software 5.3 (Cochrane Collaboration, the Nordic Cochrane Centre, Copenhagen, Denmark) was used for conducting all statistical analyses. Results This meta-analysis demonstrated that LNR > 0.2 significantly correlated with worse survival (hazard ratio [HR]: 1.84; 95% CI: 1.74-1.94; p ≤ 0.00001) in node-positive pancreatic cancer patients. Conclusions Our findings have demonstrated that a higher LNR is a predictor of poor survival and that LNR serves as an independent prognostic marker for assessing survival using a cutoff of 20%.

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“…19,20 Fifteen resected LNs are considered oncologically enough, but it has been suggested that 20 was the optimal number, especially in chemotherapy-naive patients. 21 In our specimens, a median of 26 LNs were retrieved, which alludes to the extent of peripancreatic lymphoid tissue clearance and compares favorably to the number of examined LNs reported by most established pancreatic centers. 22…”

Section: Discussionmentioning

confidence: 61%

Portal-Mesenteric Vein Resection in Borderline Pancreatic Cancer; 33 Month-Survival in Patients with Good Performance Status

Tsiotos

Ballian

Michelakos

et al. 2019

Journal of Pancreatic Cancer

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Background: Patients with pancreatic cancer (PC), which is not upfront resectable, but borderline, involving major peripancreatic vessels, have not been generally considered for surgery, considering that resection in such a setting may be futile.Materials and Methods: Retrospective analysis of prospectively collected data on patients with borderline pancreatic adenocarcinoma undergoing pancreatectomy en-block with portal and/or superior mesenteric vein resection in a tertiary referral center in Greece between January 2012 and February 2017. Follow-up was complete up to January 2018.Results: Twenty-four patients were included. Neoadjuvant therapy (NAT) was administered to only 38%, but more commonly in the second half of the group (58% vs. 17%, p = 0.035). It was associated with smaller tumor size (median: 2.5 vs. 4.2 cm, p < 0.001), fewer positive lymph nodes (LNs) in the resected specimen (median: 2 vs. 5, p = 0.04), and higher likelihood of adjuvant therapy (78% vs. 40%, p = 0.01), but not with survival. Resection was extensive: a median of 26 LNs were retrieved, R0 resection rate (≥1 mm) was 79%, and median length of vein segments was 4 cm, requiring interposition grafts in 58% (mostly polytetrafluoroethylene). Median intensive care unit stay was 0 days and length of hospital stay was 9 days. Post-operative mortality was 12.5%. Median overall survival was 24 months. Eastern Cooperative Oncology Group (ECOG) status was significantly associated with survival (p < 0.001) with ECOG-0: 33 months, ECOG-1: 12 months, and ECOG-2: 6 months.Conclusion: This first Greek national series of portomesenteric vein resection in borderline PC demonstrates that it results to 2 years of median survival, extending to 33 months in patients with good performance status, especially if NAT is uniformly administered.

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A Comprehensive Assessment of Accurate Lymph Node Staging and Preoperative Detection in Resected Pancreatic Cancer

Cited by 25 publications

References 35 publications

Lymph node ratio as valuable predictor in pancreatic cancer treated with R0 resection and adjuvant treatment

Lymph node ratio as valuable predictor in pancreatic cancer treated with R0 resection and adjuvant treatment

Lymph Node Ratio as a Prognostic Marker in Pancreatic Cancer Survival: A Systematic Review and Meta-Analysis

Portal-Mesenteric Vein Resection in Borderline Pancreatic Cancer; 33 Month-Survival in Patients with Good Performance Status

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