Lymph Node Ratio as a Prognostic Marker in Pancreatic Cancer Survival: A Systematic Review and Meta-Analysis

Karjol, Uday; Chandranath, Ajay; Jonnada, Pavan Kumar; Cherukuru, Sushma; Annavarjula, Vinitha; Morla, Srinivas Ayyappa

doi:10.7759/cureus.9597

Cited by 8 publications

(8 citation statements)

References 18 publications

(49 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Many histopathological factors were investigated in relation to the prognostic outcomes of patients with PDAC, including tumor size, number of lymph nodes (LNs), tumor grade, stage, and margin status of the resected specimen. Lymph node metastasis was considered an important factor for predicting overall survival and RFS in patients with non-metastatic pancreatic cancer who underwent surgery [40,41], which is consistent with our study. At present, the majority of patients with PDAC are estimated for staging using contrast-enhanced spiral computed tomography (CT).…”

Section: Discussionsupporting

confidence: 90%

Optimal Value of CA19-9 Determined by KRAS-Mutated Circulating Tumor DNA Contributes to the Prediction of Prognosis in Pancreatic Cancer Patients

Watanabe

Suzuki

Tamaki

et al. 2021

Preprint

View full text Add to dashboard Cite

Despite the acceptance of carbohydrate antigen 19-9 (CA19-9) as a valuable predictor for the prognosis of pancreatic ductal adenocarcinoma (PDAC), controversy remains with regards to its cutoff. Our previous study showed a significant correlation between CA19-9 levels and the presence of KRAS-mutated ctDNA in the blood of patients with PDAC. Based on this correlation, we investigated the optimal cutoff value of CA19-9 before surgery. Continuous CA19-9 values and KRAS-mutated ctDNAs were monitored in 22 patients with unresectable PDAC who underwent chemotherapy between 2015 and 2017. Receiver operating characteristic curve analysis identified 949.7 U/mL of CA19-9 as the cutoff value corresponding to the presence of KRAS-mutated ctDNA. The median value of CA19-9 was 221.1 U/mL. These values were then verified for their prognostic values of recurrence-free survival (RFS) and overall survival (OS) in 60 patients who underwent surgery between 2005 and 2013. Multivariate analysis revealed that 949.7 U/mL of CA19-9 was an independent risk factor for OS and RFS in these patients (P=0.001 and P=0.010, respectively), along with lymph node metastasis (P=0.008 and P=0.017), but the median CA19-9 level was not (P=0.150 and P=0.210). The optimal CA19-9 level contributes to the prediction of prognosis in patients with PDAC before surgery.

show abstract

Section: Discussionsupporting

confidence: 90%

Optimal Value of CA19-9 Determined by KRAS-Mutated Circulating Tumor DNA Contributes to the Prediction of Prognosis in Pancreatic Cancer Patients

Watanabe

Suzuki

Tamaki

et al. 2021

Preprint

View full text Add to dashboard Cite

show abstract

“…In other studies, a patient's R-status was independently associated with long-term survival [44]. On the other hand, the number of positive lymph nodes is consistently associated with OS in most studies and evidence demonstrates that there is a negative association between OS and LNR in N1 patients [48,49]. LNR can therefore be an important tool, more so than the number of lymph nodes harvested [48], but the AUC we obtained was between 0.6 and 0.7 which indicates a poor ability of this factor to discriminate patients with better OS and DFS in our study.…”

Section: Discussionmentioning

confidence: 93%

Tumor Stroma Area and Other Prognostic Factors in Pancreatic Ductal Adenocarcinoma Patients Submitted to Surgery

Amaral

Freitas

et al. 2023

Diagnostics

View full text Add to dashboard Cite

Pancreatic ductal adenocarcinoma (PDAC) has a dense stroma, responsible for up to 80% of its volume. The amount of stroma can be associated with prognosis, although there are discrepancies regarding its concrete impact. The aim of this work was to study prognostic factors for PDAC patients submitted to surgery, including the prognostic impact of the tumor stroma area (TSA). A retrospective study with PDAC patients submitted for surgical resection was conducted. The TSA was calculated using QuPath-0.2.3 software. Arterial hypertension, diabetes mellitus, and surgical complications Clavien–Dindo>IIIa are independent risk factors for mortality in PDAC patients submitted to surgery. Regarding TSA, using >1.9 × 1011 µ2 as cut-off value for all stages, patients seem to have longer overall survival (OS) (31 vs. 21 months, p = 0.495). For stage II, a TSA > 2 × 1011 µ2 was significantly associated with an R0 resection (p = 0.037). For stage III patients, a TSA > 1.9 × 1011 µ2 was significantly associated with a lower histological grade (p = 0.031), and a TSA > 2E + 11 µ2 was significantly associated with a preoperative AP ≥ 120 U/L (p = 0.009) and a lower preoperative AST (≤35 U/L) (p = 0.004). Patients with PDAC undergoing surgical resection with preoperative CA19.9 > 500 U/L and AST ≥ 100 U/L have an independent higher risk of recurrence. Tumor stroma could have a protective effect in these patients. A larger TSA is associated with an R0 resection in stage II patients and a lower histological grade in stage III patients, which may contribute to a longer OS.

show abstract

“…[ 13 - 14 ] Several factors associated with lymph node characteristic were investigated, such as harvested lymph node, metastatic lymph node ratio, or logarithm of the odds of metastatic lymph node. [ 5 , 15 , 16 ] The seventh edition of AJCC TNM system classified the Node stage only as N0 and N1. As suggested and validated by the previous studies, the eight edition of the staging system was updated and subdivided the lymph node status into N0 (no metastatic lymph node), N1 (1–3 metastatic lymph node), and N2 (≥4 metastatic lymph node).…”

Section: Discussionmentioning

confidence: 99%

“…[ 3 ] The relationship between the number of metastatic lymph nodes and poor survival has been demonstrated in the literature. [ 4 , 5 ]…”

mentioning

confidence: 99%

Effects of the largest metastatic lymph node size on the outcomes of patients who underwent pancreaticoduodenectomy for pancreatic ductal adenocarcinoma

Bozkurt¹

2022

Sisli Etfal

View full text Add to dashboard Cite

Objectives: Prognostic importance of metastatic lymph nodes in pancreatic cancer is always garnered attention due to dismal prognosis, with some quantitative factors drawing attention for significantly predicting outcomes. Size is one of the easy approach morphological characteristics of the lymph node, and data for effect of largest metastatic lymph node (LMLN) size on survival outcomes are lacking in pancreatic cancer. We aim to evaluate the effect of LMLN size on the prognosis of patients with pancreatic ductal adenocarcinoma (PDAC). Methods: This retrospective study evaluates the effect of LMLN size on survival outcomes by grouping the patients who were surgically treated for PDAC, according to their lymph node stage and calculated cutoff value for LMLN size, between February 2015 and May 2020. Results: In the study cohort of 131 patients, the mean age was 63.9±10.8 years and 77 patients were female. Ninety-nine of the patients had pN1, 32 had pN2 stage disease. The optimal cutoff point of LMLN size for predicting the prognosis was calculated as 7.5 mm (sensitivity = 81% and specificity = 81%). 34 (34.3%) of pN1 and 7 (21.9%) of pN2-staged patients had lymph node smaller than 7.5 mm. Three-year survival was significantly longer for patients whose LMLN size was <7.5 mm (56.2–18.2%, p<0.001). Whereas, the patients with LMLN size <7.5 mm had statistically significant longer median survival rate in the subgroup of patients with pN1 lymph node stage, no significant difference in median survival rates was observed between subgroups of pN2 patients (p=0.237). Conclusion: The present study demonstrated that the LMLN size was one of the potential predictors of survival in patients with PDAC.

show abstract

Lymph Node Ratio as a Prognostic Marker in Pancreatic Cancer Survival: A Systematic Review and Meta-Analysis

Cited by 8 publications

References 18 publications

Optimal Value of CA19-9 Determined by KRAS-Mutated Circulating Tumor DNA Contributes to the Prediction of Prognosis in Pancreatic Cancer Patients

Optimal Value of CA19-9 Determined by KRAS-Mutated Circulating Tumor DNA Contributes to the Prediction of Prognosis in Pancreatic Cancer Patients

Tumor Stroma Area and Other Prognostic Factors in Pancreatic Ductal Adenocarcinoma Patients Submitted to Surgery

Effects of the largest metastatic lymph node size on the outcomes of patients who underwent pancreaticoduodenectomy for pancreatic ductal adenocarcinoma

Contact Info

Product

Resources

About