Prognostic Factors and Lymph Node Metastasis Patterns of Primary Duodenal Cancer

Abstract

Background The effectiveness and extent of regional lymph node dissection in primary duodenal cancer (DC) remains unclear. This study aimed to analyze the prognostic factors and lymph node metastasis (LNM) patterns in DC. Methods Fifty-three patients who underwent surgical resection for DC between January 1998 and December 2018 at two institutions were retrospectively analyzed. Univariate and multivariate analyses were performed on the prognostic factors of resected DC. Moreover, the relationships between depth of tumor invasion and incidence of LNM and between tumor location and LNM stations were analyzed. ResultsThe five-year survival rate of the study population was 68.9%. Multivariate survival analysis demonstrated that histologic grade G2-G4, presence of LNM, pT3-4, and elevated preoperative CA19-9 were the independent poor prognostic factors. No patient with pTis-T2 had LNM. On the other hand, LNM was found in 70% of patients with pT3-4. Among 36 patients who underwent pancreaticoduodenectomy (PD), LNM around the pancreatic head was observed, regardless of the duodenal cancer site, including the duodenal bulb and the third to the fourth portion. Conclusions Histologic grade G2-G4, presence of LNM, pT3-T4, and elevated preoperative CA19-9 were the independent poor prognostic factors in patients with resected DC. Our results suggested that lymph node dissection could be omitted for DC Tis-T1a. Moreover, based on the high frequency of LNM in T3-4 cases, PD with lymph node dissection in the pancreatic head region was considered necessary for T3-4 DC at any site.

A DNA-Methylation-Driven Genes Based Prognostic Signature Reveals Immune Microenvironment in Pancreatic Cancer

“…1We investigated whether some important clinicopathological features, namely histologic grades (G grades, G1: well differentiated, G2: moderately differentiated, G3: poorly differentiated, G4: undifferentiated) ( 48 , 49 ) and TNM stages, which have long been ascertained to be prognostic in PACA patients ( 50 , 51 ), were correlated with our signature. In all the four datasets TCGA-PAAD, E-MTAB-6134, GSE62452 and GSE78229 providing G grade data, highly graded samples tended to exhibit higher risk-scores ( Figure S4A ), indicating that higher risk-scores may be associated with lower differentiated and more malignant tumors.…”

Efficacy of lymph node dissection for duodenal cancer according to the lymph node station

“…In this study, dissected LN stations were classified into six regional LN stations: the supra-pyloric LN station, sub-pyloric LN station, hepatic artery (HA) LN station (along the celiac axis to the common hepatic artery), hepatoduodenal ligament (HDL) LN station, peri-Ph LN station, and SM LN station (Figure 1). Additionally, the gastric and mesojejunal LN stations were also examined 3,12,14,15 (Figure 1). Subsequently, based on previous reports 3,4,[12][13][14] and the anatomical features of the lymphatic flow, 11 these LN stations were categorized into two groups based on the tumor location: stations located upstream in the lymphatic flow, defined as the Np (proximal node) stations, and those located downstream, defined as the Nd (distal node) stations.…”

“…Additionally, the gastric and mesojejunal LN stations were also examined 3,12,14,15 (Figure 1). Subsequently, based on previous reports 3,4,[12][13][14] and the anatomical features of the lymphatic flow, 11 these LN stations were categorized into two groups based on the tumor location: stations located upstream in the lymphatic flow, defined as the Np (proximal node) stations, and those located downstream, defined as the Nd (distal node) stations. The peri-Ph LN station was resolutely defined as the Np station in all cases due to its proximity to the tumor and its upstream position in the lymphatic flow, 11,13 regardless of the tumor location.…”

“…Previous reports have indicated that the most frequent area of LNM differs according to the tumor location. 3,4,[12][13][14] For instance, tumors located in the first portion are expected to be more likely to metastasize to hepatic LNs than SM LNs. 3 However, the current UICC-TNM classification defines only the number of metastatic LNs as a prognostic factor, and the association between the location of LNM and prognosis has not been verified, with the appropriate extent of LN dissection being undefined.…”

“…Previous reports have indicated that the most frequent area of LNM differs according to the tumor location 3,4,12–14 . For instance, tumors located in the first portion are expected to be more likely to metastasize to hepatic LNs than SM LNs 3 .…”