A systematic review of the prognostic value of lymph node ratio, number of positive nodes and total nodes examined in pancreatic ductal adenocarcinoma

Abstract

BACKGROUND Pancreatic ductal adenocarcinoma is the most common pancreatic cancer. Five-year overall survival is currently 3.3-6.0%. The aim of this review was to evaluate the prognostic value of lymph node ratio, number of positive nodes and total nodes examined on overall survival rate following pancreatic resection. MATERIALS AND METHODS A literature search was conducted of MEDLINE, EMBASE, the Cochrane Library and Central Register of Controlled Trials and the Cochrane Database of Systematic Review databases, from January 1996 to January 2016. RESULTS Overall, 19 studies including 4,883 patients examined the relationship between lymph node ratio and overall survival. A high lymph node ratio was associated with decreased overall survival in 17 studies. A total of 12 studies examined the relationship between the number of positive nodes and overall survival, and 11 studies revealed that an increase in the number of positive nodes was associated with decreased overall survival. In 15 studies examining the relationship between the total nodes examined and overall survival, there was no association with overall survival in 12 studies. CONCLUSIONS Lymph node ratio and number of positive nodes are factors associated with overall survival in pancreatic ductal adenocarcinoma, but not total nodes examined.

Impact of resection margin status on recurrence and survival in pancreatic cancer surgery

“…This may be related to incomplete resection of the tumour and a consequence of high recurrence rates. Other factors affecting outcome include tumour size, perineural and/or lymphangioinvasion and lymph node status. Resection margin (R) status remains the most controversial.…”

Evaluation of lymph node ratio and lymph node yield as prognosticators of locoregional recurrence in p16‐associated oropharyngeal squamous cell carcinoma

“…LNR incorporates both LNY and traditional lymph node staging and serves as a means to account for both number of pathologic lymph nodes and the quality of the extent of neck dissection with LNY. LNR has been shown to be useful prognostic indicators of survival outcomes for bladder, 16 pancreatic, 17 and stomach 18,19 cancers. It has also been shown to serve as a prognostic factor for patients with thyroid and oral cavity head and neck cancers 20‐24 .…”

Microvascular invasion is a major prognostic factor after pancreatico‐duodenectomy for adenocarcinoma

“…These results lead to the current staging system for pancreatic cancer that stratifies LN+ patients according to the number of LN metastases. Recently, the lymph node ratio (LNR) was reported as a better parameter than LN status to predict long‐term outcomes . Bias due to the number of LNs retrieved is eliminated when considering this parameter.…”

“…Recently, the lymph node ratio (LNR) was reported as a better parameter than LN status to predict long-term outcomes. 14 The aim of this study was to assess the impact of MVI, on diseasefree survival (DFS), and overall survival (OS), after pancreaticoduodenectomy (PD) for pancreatic head adenocarcinoma.…”