Clinical Implications of Extensive Lymph Node Metastases for Resected Pancreatic Cancer

Lowder, Cinthya Y.; Metkus, James; Epstein, Jeffrey D.; Kozak, Geoffrey M.; Lavu, Harish; Yeo, Charles J.; Winter, Jordan M.

doi:10.1245/s10434-018-6763-4

Cited by 21 publications

(26 citation statements)

References 36 publications

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“…Lymph node metastasis is a poor prognostic factor in patients with PDAC [5][6][7][8]12]. To better understand the relationship between lymph node size and metastases, we comprehensively evaluated all harvested lymph nodes by measuring the size along the long and short axes and compared the lymph node size and metastasis.…”

Section: Discussionmentioning

confidence: 99%

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Lymph node size and its association with nodal metastasis in ductal adenocarcinoma of the pancreas

Shin

Lee

et al. 2020

J Pathol Transl Med

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Background: Although lymph node metastasis is a poor prognostic factor in patients with pancreatic ductal adenocarcinoma (PDAC), our understanding of lymph node size in association with PDAC is limited. Increased nodal size in preoperative imaging has been used to detect node metastasis. We evaluated whether lymph node size can be used as a surrogate preoperative marker of lymph node metastasis. Methods: We assessed nodal size and compared it to the nodal metastatic status of 200 patients with surgically resected PDAC. The size of all lymph nodes and metastatic nodal foci were measured along the long and short axis, and the relationships between nodal size and metastatic status were compared at six cutoff points. Results: A total of 4,525 lymph nodes were examined, 9.1% of which were metastatic. The mean size of the metastatic nodes (long axis, 6.9 ± 5.0 mm; short axis, 4.3 ± 3.1 mm) was significantly larger than that of the non-metastatic nodes (long axis, 5.0 ± 4.0 mm; short axis, 3.0 ± 2.0 mm; all p < .001). Using a 10 mm cutoff, the sensitivity, specificity, positive predictive value, overall accuracy, and area under curve was 24.8%, 88.0%, 17.1%, 82.3%, and 0.60 for the long axis and 7.0%, 99.0%, 40.3%, 90.6%, and 0.61 for the short axis, respectively. Conclusions: The metastatic nodes are larger than the non-metastatic nodes in PDAC patients. However, the difference in nodal size was too small to be identified with preoperative imaging. The performance of preoperative radiologic imaging to predict lymph nodal metastasis was not good. Therefore, nodal size cannot be used a surrogate preoperative marker of lymph node metastasis.

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Section: Discussionmentioning

confidence: 99%

“…Lymph node metastasis is a poor prognostic factor in patients with PDAC [5][6][7][8]. Nodal status and quantity are important, and nodal (N) staging is classified based on the number of metastatic lymph nodes, as N0 (0), N1 (1-3), and N2 (≥ 4), in the 8th edition of the American Joint Committee on Cancer [9].…”

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confidence: 99%

Lymph node size and its association with nodal metastasis in ductal adenocarcinoma of the pancreas

Shin

Lee

et al. 2020

J Pathol Transl Med

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“…A high postoperative CA19‐9 level is a well‐established biomarker predicting the prognosis of patients with resected PDAC 4,10‐14 . A high postoperative CA19‐9 level (>37 U/mL) is a risk factor affecting early postoperative recurrence and poor survival 15‐17 .…”

Section: Surgical Treatmentmentioning

confidence: 99%

Essential updates 2018/2019: Current topics in the surgical treatment of pancreatic ductal adenocarcinoma

Ishido

Hakamada

Kimura

et al. 2020

Annals of Gastroent Surgery

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Pancreatic ductal adenocarcinoma (PDAC) is highly malignant. While cancers in other organs have shown clear improvements in 5‐year survival, the 5‐year survival rate of pancreatic cancer is approximately 10%. Early relapse and metastasis are not uncommon, making it difficult to achieve an acceptable prognosis even after complete surgical resection of the pancreas. Studies have been performed on various treatments to improve the prognosis of PDAC, and multidisciplinary approaches including non‐surgical treatments have led to gradual improvement. In the present literature review, we have described the significance of anatomical and biological resectability criteria, the concept of R0 resection in surgical treatment, the feasibility of minimally invasive surgery, the remarkable development of perioperative chemotherapy, the effectiveness of conversion surgery for unresectable PDAC, and ongoing challenges in PDAC treatment. We also provide an essential update on these subjects by focusing on recent trends and topics.

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“…5,12,13 Asano et al showed that the median overall survival was 56 months in the N0 group, 34 months in the N1 group, and 20 months in the N2 group for patients with pancreatic head ductal adenocarcinoma who underwent pancreaticoduodenectomy. 6 Lowder et al 9 found that N2 staging was correlated with postoperative CA19-9 levels (P ¼ .044) and systemic recurrence (P < .001), indicating that extensive lymph node involvement may be associated with occult systemic disease. In this study, patients with N0 (P ¼ .006) or N1 (P < .001) disease were susceptible, while patients with N2 disease (P ¼ .867) were resistant to gemcitabine-based adjuvant chemotherapy.…”

Section: Discussionmentioning

confidence: 99%

Resected Pancreatic Cancer With N2 Node Involvement Is Refractory to Gemcitabine-Based Adjuvant Chemotherapy

Liu

Jin

et al. 2020

Cancer Control

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Lymphatic metastasis is a major determinant of the outcome of resected pancreatic cancer. Gemcitabine-based adjuvant chemotherapy can improve the outcome of resected pancreatic cancer. However, the efficacy of gemcitabine against pancreatic cancer stratified by nodal involvement is unclear. In this study, patients who had undergone curative resection of pancreatic adenocarcinoma (612 cases) were included. The efficacy of adjuvant gemcitabine-based regimen, stratified by nodal status (negative, positive) or N substage (N0, no nodal involvement; N1, 1-3-node involvement; N2, ≥4-node involvement), was examined. Both the node-negative (hazard ratio [HR] = 0.62, 95% confidence interval [CI], 0.44-0.87, P = .006) and node-positive subgroups (HR = 0.45, 95% CI, 0.33-0.62, P < .001) benefited from gemcitabine-based adjuvant chemotherapy. Patients with N0 (ie, the node-negative subgroup) or N1 (HR = 0.36, 95% CI, 0.25-0.52, P < .001) disease benefited from gemcitabine-based chemotherapy. However, patients with N2 tumors (HR = 0.95, 95% CI, 0.50-1.78, P = .867) had poor response to gemcitabine-based treatment. Therefore, we postulate that resected pancreatic cancer with N2 node involvement is refractory to gemcitabine-based adjuvant chemotherapy. A more intensive adjuvant regimen may be required for N2 subgroup patients.

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Clinical Implications of Extensive Lymph Node Metastases for Resected Pancreatic Cancer

Cited by 21 publications

References 36 publications

Lymph node size and its association with nodal metastasis in ductal adenocarcinoma of the pancreas

Lymph node size and its association with nodal metastasis in ductal adenocarcinoma of the pancreas

Essential updates 2018/2019: Current topics in the surgical treatment of pancreatic ductal adenocarcinoma

Resected Pancreatic Cancer With N2 Node Involvement Is Refractory to Gemcitabine-Based Adjuvant Chemotherapy

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