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

Li, Yufeng; Xiang, Yucheng; Zhang, Qiuqiang; Wang, Weilin

doi:10.21037/jgo-20-158

Cited by 3 publications

(11 citation statements)

References 28 publications

(37 reference statements)

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“…LN metastasis reflects cancer survival and guides treatment strategies after surgery [4,6,13,14]. Sufficient lymphadenectomy provides accurate nodal staging and prevents stage migration [4,8].…”

Section: Discussionmentioning

confidence: 99%

“…Sufficient lymphadenectomy provides accurate nodal staging and prevents stage migration [4,8]. Higher lymph node ratio (i.e., the count of metastatic LN divided by the total count of ELN) indicates a poor prognosis for PC [4][5][6][7][8][9] as well as other gastrointestinal malignancies such as gastric [15] and colorectal [16] carcinoma. Patients with more ELNs also have a better prognosis with or without the presence of metastatic LNs [4][5][6][7][8][9].…”

Section: Discussionmentioning

confidence: 99%

“…Higher lymph node ratio (i.e., the count of metastatic LN divided by the total count of ELN) indicates a poor prognosis for PC [4][5][6][7][8][9] as well as other gastrointestinal malignancies such as gastric [15] and colorectal [16] carcinoma. Patients with more ELNs also have a better prognosis with or without the presence of metastatic LNs [4][5][6][7][8][9]. Huebner et al [4] found that patients with >11 ELNs had better overall survival than those with <11 (HR: 1.33, 95% CI: 1.1-1.7; P=0.001) after PD for pancreatic cancer in pN0 patients.…”

Section: Discussionmentioning

confidence: 99%

“…Huebner et al [4] found that patients with >11 ELNs had better overall survival than those with <11 (HR: 1.33, 95% CI: 1.1-1.7; P=0.001) after PD for pancreatic cancer in pN0 patients. Recently, ELN >11 [5], >12 [6], and >20 [17], respectively, were associated with better overall survival in pN0 patients after undergoing distal pancreatectomy for pancreatic body/tail cancer. Slidell et al [7] reported the importance of more than 12 ELN in identifying stratified survival for all locations of PC patients.…”

Section: Discussionmentioning

confidence: 99%

“…Accurate staging determined with LN status guides postoperative adjuvant treatment strategy [4]. In addition, the number of examined lymph nodes (ELNs) reflects survival; more ELN is associated with prolonged survival with or without the presence of metastatic lymph nodes [4][5][6][7][8][9][10]. Therefore, sufficient lymphadenectomy during surgery may improve pancreatic cancer survival without considering tumor localization.…”

Section: Introductionmentioning

confidence: 99%

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

Özşay¹,

Aydın²

2022

Journal of Surgery and Medicine

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Background/Aim: One of the important prognostic factors for pancreatic cancer is the count of examined lymph nodes (ELN). The ratio of metastatic to ELNs reflects survival and is required for accurate staging. The survival effect of the count of ELNs in patients with an absence of metastatic lymph nodes is unclear. However, the single-center survival outcomes related to higher ELN count based on only lymph node negative-patients are limited to a few studies with controversial results. We aimed to present the singlecenter experience in survival outcomes based on ELN count in patients with lymph node-negative pancreatic head cancer after pancreaticoduodenectomy. Methods: The data of 129 patients who underwent pancreaticoduodenectomy for pancreatic cancer from October 2011-December 2021 were analyzed. Among them, those who had metastatic lymph nodes, those who died from non-PC causes, died in the first 90 days postoperatively, or had missing follow-up data were excluded. Finally, 37 patients with negative lymph nodes who satisfied our criteria were included. The cut-off value for the examined lymph node count was 15, according to the minimum LN count recommended by the International Study Group of Pancreatic Surgery and the European Society for Medical Oncology for accurate staging. Thus, node-negative patients were divided into ELN <15 and ≥15 groups. The effect of <15 and ≥15 ELN count, tumor T stage, tumor grade, presence or absence of lymphovascular invasion and perineural invasion, and the resection margin status on cancer-specific survival were evaluated by univariate and multivariate survival analyses. Results: The median age was 63 years (interquartile range (IQR) 55.50-75.0), and 17 (45.9%) were female. The median count of examined lymph nodes was 15. The median follow-up time was 36.5 months ). The 1-3-5-years of cancer-specific survivals were 86.2%, 61.5%, 49.6%, respectively. Seventeen patients died due to pancreatic carcinoma during the follow-up period, and 12 out of 17 patients were in the <15 group. In multivariate analyses, the examined lymph node count <15 was a negative independent risk factor for cancer-specific survival (HR: 0.293; 95% CI, 0.096-0.897; P=0.032). The other negative independent risk factor was a positive resection margin (HR: 5.777; 95% CI, 1.436-23.245; P=0.014). Conclusion: Patients with node-negative pancreatic head cancer with <15 ELN count, and positive resection margin have shorter survival, suggesting missed metastatic lymph nodes due to assessment of too few lymph nodes. At least a 15 ELN count is required to stratify the survival more accurately in these cohorts.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Özşay¹,

Aydın²

2022

Journal of Surgery and Medicine

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

et al. 2022

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Background Nodal disease is prognostic in pancreatic ductal adenocarcinoma (PDAC); however, optimal number of examined lymph nodes (ELNs) required to accurately stage nodal disease in the current era of neoadjuvant therapy remains unknown. The aim of the study was to evaluate the optimal number of ELNs in patients with neoadjuvantly treated PDAC. Methods A retrospective study was performed on patients with PDAC undergoing resection following neoadjuvant treatment between 2011 and 2018. Clinicopathological data were extracted and analyzed. Results Of 546 patients included, 232 (42.5%) had lymph node metastases. The median recurrence free survival (RFS) was 10.6 months (95% confidence interval: 9.7–11.7) and nodal disease was independently associated with shorter RFS (9.1 vs 11.9 months; p < 0.001). A cutoff of 22 ELNs was identified that stratified patients by RFS. Patients with N1 and N2 disease had similar median RFS (9.1 vs 8.9 months; p = 0.410). On multivariable analysis, ELN of ≥ 22 was found to be significantly associated with longer RFS among patients with N0 disease (14.2 vs. 10.9 months, p = 0.046). However, ELN has no impact on RFS for patients with N1/N2 disease (9.5 vs. 8.4 months, p = 0.190). Adjuvant therapy was associated with RFS only in patients with residual nodal disease. Conclusions Lymph node metastases remain prognostic in PDAC patients after neoadjuvant treatment. Among N0 patients, a cutoff of 22 ELN was associated with improved RFS and resulted in optimal nodal staging.

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Surgical treatment of pancreatic cancer: Currently debated topics on morbidity, mortality, and lymphadenectomy

Pedrazzoli

2022

Surgical Oncology

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

Cited by 3 publications

References 28 publications

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

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

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

Surgical treatment of pancreatic cancer: Currently debated topics on morbidity, mortality, and lymphadenectomy

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