Impact of examined lymph node count on prognosis in patients with lymph node-negative pancreatic body/tail ductal adenocarcinoma

Abstract

Background: Because the overall prognosis remains dismal for patients with resected pancreatic cancer (PC), we aimed to explore the prognostic impact of examined lymph node (ELN) count on lymph node (LN)-negative pancreatic body/tail ductal adenocarcinoma. Methods: Patients' data were extracted from the Surveillance, Epidemiology, and End Results (SEER) database (National Cancer Institute, USA) to investigate the relationship between ELN count and survival outcomes of LN-negative pancreatic body/tail ductal adenocarcinoma. Results: A total of 700 patients were included, and the median number of ELNs was 11. The respective 1-, 3-, 5-year overall survival (OS) rates were 75.3%, 37.7%, 30.3%, and the 1-, 3-, 5-year cancer-specific survival (CSS) were 78.3%, 41.7%, 34.5%. The X-tile analysis showed that 14 was the most optimal cutoff for both OS and CSS. Kaplan-Meier survival analysis indicated that patients with ELNs >14 had better OS and CSS than ELNs ≤14. Multivariate Cox analysis showed ELNs ≤14 was an independent risk factor for both OS [hazard ratio (HR), 1.357; 95% confidence interval (CI), 1.080-1.704; P=0.

Prognostic value of examined lymph node count in patients with lymph node negative pancreatic head carcinoma: A single-center experience

“…Lidsky et al [18] reported that high-volume medical centers have higher ELN counts and improved survival. Fortunately, the median count of ELN (15, in this cohort was similar to those presented in the critical studies [6,7]. Some scenarios may explain how an increased ELN count is associated with improved survival in pN0 patients and include the quality of surgery and pathological evaluation.…”

“…Increased ELN count was reflected in improved survival in pN0 PC patients. In this study, survival rates of 1, 3, 5 years, respectively, were better than in population-based studies [4][5][6][7][8][9]. This result may be related to the small number of patients, which was the main limitation of our study.…”

Prognostic value of examined lymph node count in patients with lymph node negative pancreatic head carcinoma: A single-center experience

“…Lidsky et al [18] reported that high-volume medical centers have higher ELN counts and improved survival. Fortunately, the median count of ELN (15, in this cohort was similar to those presented in the critical studies [6,7]. Some scenarios may explain how an increased ELN count is associated with improved survival in pN0 patients and include the quality of surgery and pathological evaluation.…”

“…Increased ELN count was reflected in improved survival in pN0 PC patients. In this study, survival rates of 1, 3, 5 years, respectively, were better than in population-based studies [4][5][6][7][8][9]. This result may be related to the small number of patients, which was the main limitation of our study.…”

Accurate Nodal Staging in Pancreatic Cancer in the Era of Neoadjuvant Therapy

“…Strobel et al [28] demonstrated that the number of positive lymph nodes had a significant correlation with increasing ELN. The past studies based on large national datasets have recommended an optimal cutoff for ELN to be between 11 and 16 for accurate nodal staging [12, 16, 29–32]. These findings guide the current NCCN guidelines for the management of PDAC.…”

“…Li. et al [32] also observed that in patients with node‐negative disease a cutoff of more than 14 ELNs was able to stratify patients based on overall survival. Masuda et al [17] identified an ELN of 20 as the optimal number in chemo‐naïve patients.…”

Pan-Asian adapted ESMO Clinical Practice Guidelines for the diagnosis, treatment and follow-up of patients with pancreatic cancer

“…While the International Study Group on Pancreatic Surgery (ISGPS) suggested a minimum of 12-15 lymph nodes (including lymph node stations 5, 6, 8a, 12b1, 12b2, 12c, 13a, 13b, 14a, 14b, 17a and 17b, and, for cancers of the body and tail of the pancreas, also stations 10, 11 and 18), 32 several large retrospective studies have suggested that a minimum of 11-19 lymph nodes are required for improved staging and prognostication. 33 , 34 , 35 Thus, it was agreed as per the original ESMO recommendation that ≥16 lymph nodes should be resected. It was agreed that the wording of the recommended be modified to underline the importance that all resected nodes be examined to allow for adequate pathological staging, as shown in bold below and in Table 2 ( 100% consensus ) to read: Standard lymphadenectomy is recommended and should involve the removal and pathological examination of ≥16 lymph nodes to allow adequate pathological staging of the disease [IV, A ; consensus = 100% ].…”

Prognostic value of examined lymph node count in patients with lymph node negative pancreatic head carcinoma: A single-center experience

“…Lidsky et al [18] reported that high-volume medical centers have higher ELN counts and improved survival. Fortunately, the median count of ELN (15, in this cohort was similar to those presented in the critical studies [6,7]. Some scenarios may explain how an increased ELN count is associated with improved survival in pN0 patients and include the quality of surgery and pathological evaluation.…”

“…Increased ELN count was reflected in improved survival in pN0 PC patients. In this study, survival rates of 1, 3, 5 years, respectively, were better than in population-based studies [4][5][6][7][8][9]. This result may be related to the small number of patients, which was the main limitation of our study.…”

Accurate Nodal Staging in Pancreatic Cancer in the Era of Neoadjuvant Therapy

“…Strobel et al [28] demonstrated that the number of positive lymph nodes had a significant correlation with increasing ELN. The past studies based on large national datasets have recommended an optimal cutoff for ELN to be between 11 and 16 for accurate nodal staging [12, 16, 29–32]. These findings guide the current NCCN guidelines for the management of PDAC.…”

“…Li. et al [32] also observed that in patients with node‐negative disease a cutoff of more than 14 ELNs was able to stratify patients based on overall survival. Masuda et al [17] identified an ELN of 20 as the optimal number in chemo‐naïve patients.…”

Pan-Asian adapted ESMO Clinical Practice Guidelines for the diagnosis, treatment and follow-up of patients with pancreatic cancer

“…While the International Study Group on Pancreatic Surgery (ISGPS) suggested a minimum of 12-15 lymph nodes (including lymph node stations 5, 6, 8a, 12b1, 12b2, 12c, 13a, 13b, 14a, 14b, 17a and 17b, and, for cancers of the body and tail of the pancreas, also stations 10, 11 and 18), 32 several large retrospective studies have suggested that a minimum of 11-19 lymph nodes are required for improved staging and prognostication. 33 , 34 , 35 Thus, it was agreed as per the original ESMO recommendation that ≥16 lymph nodes should be resected. It was agreed that the wording of the recommended be modified to underline the importance that all resected nodes be examined to allow for adequate pathological staging, as shown in bold below and in Table 2 ( 100% consensus ) to read: Standard lymphadenectomy is recommended and should involve the removal and pathological examination of ≥16 lymph nodes to allow adequate pathological staging of the disease [IV, A ; consensus = 100% ].…”

Prognostic value of examined lymph node count in patients with lymph node negative pancreatic head carcinoma: A single-center experience

“…Lidsky et al [18] reported that high-volume medical centers have higher ELN counts and improved survival. Fortunately, the median count of ELN (15, in this cohort was similar to those presented in the critical studies [6,7]. Some scenarios may explain how an increased ELN count is associated with improved survival in pN0 patients and include the quality of surgery and pathological evaluation.…”

“…Increased ELN count was reflected in improved survival in pN0 PC patients. In this study, survival rates of 1, 3, 5 years, respectively, were better than in population-based studies [4][5][6][7][8][9]. This result may be related to the small number of patients, which was the main limitation of our study.…”

Accurate Nodal Staging in Pancreatic Cancer in the Era of Neoadjuvant Therapy

“…Strobel et al [28] demonstrated that the number of positive lymph nodes had a significant correlation with increasing ELN. The past studies based on large national datasets have recommended an optimal cutoff for ELN to be between 11 and 16 for accurate nodal staging [12, 16, 29–32]. These findings guide the current NCCN guidelines for the management of PDAC.…”

“…Li. et al [32] also observed that in patients with node‐negative disease a cutoff of more than 14 ELNs was able to stratify patients based on overall survival. Masuda et al [17] identified an ELN of 20 as the optimal number in chemo‐naïve patients.…”

Pan-Asian adapted ESMO Clinical Practice Guidelines for the diagnosis, treatment and follow-up of patients with pancreatic cancer

“…While the International Study Group on Pancreatic Surgery (ISGPS) suggested a minimum of 12-15 lymph nodes (including lymph node stations 5, 6, 8a, 12b1, 12b2, 12c, 13a, 13b, 14a, 14b, 17a and 17b, and, for cancers of the body and tail of the pancreas, also stations 10, 11 and 18), 32 several large retrospective studies have suggested that a minimum of 11-19 lymph nodes are required for improved staging and prognostication. 33 , 34 , 35 Thus, it was agreed as per the original ESMO recommendation that ≥16 lymph nodes should be resected. It was agreed that the wording of the recommended be modified to underline the importance that all resected nodes be examined to allow for adequate pathological staging, as shown in bold below and in Table 2 ( 100% consensus ) to read: Standard lymphadenectomy is recommended and should involve the removal and pathological examination of ≥16 lymph nodes to allow adequate pathological staging of the disease [IV, A ; consensus = 100% ].…”