Analysis of prognostic factors for pancreatic head cancer according to para‐aortic lymph node

Lin, Jianyu; Zhang, Xing‐mao; Kou, Jian‐tiao; Fa, Hua; Zhang, Xin‐xue; Dai, Yang; He, Qiang

doi:10.1002/cam4.853

Cited by 8 publications

(12 citation statements)

References 25 publications

(43 reference statements)

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“…The impact of PDAC size on DFS was evaluated in 6 studies [ 18 , 23 – 25 , 28 , 33 ], among which univariate HR was reported in 4 [ 23 – 25 , 27 ] and multivariate HR was reported in 5 [ 18 , 23 , 25 , 28 , 33 ]. Both univariate and multivariate HR were reported in 3 studies [ 23 , 25 , 28 ].…”

Section: Resultsmentioning

confidence: 99%

Impact of tumor size on survival of patients with resected pancreatic ductal adenocarcinoma: a systematic review and meta-analysis

Zhou

Wan

et al. 2018

BMC Cancer

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BackgroundThe impact of tumor size on prognosis for surgically treated patients with pancreatic ductal adenocarcinoma (PDAC) remains controversial. A systematic review and meta-analysis was performed to evaluate this issue.MethodsRelevant studies published from January 2000 to June 2017 were identified through EMBASE and PUBMED. Data were pooled for meta-analysis using Review Manager 5.3.ResultsTwenty eight observational studies involving a total of 23,945 patients were included. Tumors > 2 cm was associated with poor prognosis: the pooled hazard ratio (HR) estimate for overall survival was 1.52 (95% confidence interval [CI]: 1.41–1.64; P < 0.0001) by univariate analysis and 1.61 (95% CI: 1.35–1.91; P < 0.0001) by multivariate analysis; the pooled HR estimate for disease-free survival was 1.74 (95% CI: 1.46–2.07; P < 0.0001) by univariate analysis and 1.38 (95% CI: 1.12–1.68; P = 0.002) by multivariate analysis. When compared with patients with tumors ≤2 cm, those with the tumors > 2 cm had higher incidences of lymph node metastasis, poor tumor differentiation, lymph vessel invasion, vascular invasion, perineural invasion, and positive intraoperative peritoneal cytology.ConclusionThese data demonstrate that PDAC size > 2 cm is an independent predictive factor for poor prognosis after surgical resection and associated with more aggressive tumor biology.

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Section: Resultsmentioning

confidence: 99%

Impact of tumor size on survival of patients with resected pancreatic ductal adenocarcinoma: a systematic review and meta-analysis

Zhou

Wan

et al. 2018

BMC Cancer

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“…Our analysis also exposed several positive prognostic factors for OS such as diagnosis after 2010, lower comorbidity score, younger age, tumor size <3 cm, nodal stage zero, and receipt of chemotherapy (P<0.05). Several of these factors have already been discussed in the literature (3,(16)(17)(18)(19)(20).…”

Section: Discussionmentioning

confidence: 99%

Stereotactic body radiotherapy for locally-advanced unresectable pancreatic cancer—patterns of care and overall survival

Dohopolski¹,

Glaser²,

Vargo³

et al. 2017

J. Gastrointest. Oncol.

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“…Tumor size [21,24] , tumor differentiation [24] , and absence of venous infiltration [21] have been identified as independent prognostic factors. Moreover, adjuvant chemotherapy has been shown to significantly improve the survival of patients with para-aortic lymph node metastasis [25][26][27] . Recently, Sho et al [28] reported a multicentric retrospective analysis of 822 patients who underwent pancreatic resection with pathological evaluation of PALNs for pancreatic ductal adenocarcinoma: metastatic PALNs were associated with poorer survival, but PALNs metastasis did not have a significant prognostic value at multivariate analysis.…”

Section: Discussionmentioning

confidence: 99%

Para-aortic node involvement is not an independent predictor of survival after resection for pancreatic cancer

et al. 2017

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AIMTo analyze the importance of para-aortic node status in a series of patients who underwent pancreaticoduodenectomy (PD) in a single Institution. METHODSBetween January 2000 and December 2012, 151 patients underwent PD with para-aortic node dissection for pancreatic adenocarcinoma in our Institution. Patients were divided into two groups: patients with negative PALNs (PALNs-), and patients with metastatic PALNs (PALNs+). Pathologic factors, including stage, nodal status, number of positive nodes and lymph node ratio, invasion of para-aortic nodes, tumor's grading, and radicality of resection were studied by univariate and multivariate analysis. Survival curves were constructed with Kaplan-Meier method and compared with Log-rank test: significance was considered as P < 0.05. RESULTSA total of 107 patients (74%) had nodal metastases. Median number of pathologically assessed lymph nodes was 26 (range 14-63). Twenty-five patients (16.5%) Retrospective Cohort Study had para-aortic lymph node involvement. Thirty-three patients (23%) underwent R1 pancreatic resection. Onehundred forty-one patients recurred and died for tumor recurrence, one is alive with recurrence, and 9 are alive and free of disease. Overall survival was significantly influenced by grading (P = 0.0001), radicality of resection (P = 0.001), stage (P = 0.03), lymph node status (P = 0.04), para-aortic nodes metastases (P = 0.02). Multivariate analysis showed that grading was an independent prognostic factor for overall survival (P = 0.0001), while grading (P = 0.0001) and radicality of resection (P = 0.01) were prognostic parameters for disease-free survival. Number of metastatic nodes, node ratio, and para-aortic nodes involvement were not independent predictors of disease-free and overall survival. ORIGINAL ARTICLE CONCLUSIONIn this experience, lymph node status and para-aortic node metastases were associated with poor survival at univariate analysis, but they were not independent prognostic factors. Core tip: Para-aortic node involvement by pancreatic cancer is traditionally considered as an advanced disease with poor prognosis. We retrospectively examined our experience of 151 patients with pancreatic cancer who underwent resection and para-aortic lymph nodes sampling. Disease-free and overall survival were worse in patients with para-aortic nodes metastases, but multivariate analysis showed that para-aortic node involvement is not an independent prognostic factor after resection of pancreatic cancer. So, the decision to make pancreatic resection should not be based on the paraaortic node status only.Sperti C, Gruppo M, Blandamura S, Valmasoni M, Pozza G, Passuello N, Beltrame V, Moletta L. Para-aortic node involvement is not an independent predictor of survival after resection for pancreatic cancer.

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Analysis of prognostic factors for pancreatic head cancer according to para‐aortic lymph node

Cited by 8 publications

References 25 publications

Impact of tumor size on survival of patients with resected pancreatic ductal adenocarcinoma: a systematic review and meta-analysis

Impact of tumor size on survival of patients with resected pancreatic ductal adenocarcinoma: a systematic review and meta-analysis

Stereotactic body radiotherapy for locally-advanced unresectable pancreatic cancer—patterns of care and overall survival

Para-aortic node involvement is not an independent predictor of survival after resection for pancreatic cancer

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