Prognostic value of lymph node metastases detected during surgical exploration for pancreatic or periampullary cancer: A systematic review and meta-analysis

Rijssen, B. van; Narwade, Poorvi; Huijgevoort, N. van; Tseng, Dorine S.J.; Santvoort, Hjalmar van; Molenaar, I. Quintus; Laarhoven, H.W.M. van; Eijck, Casper van; Busch, Olivier R.; Besselink, Marc G.

doi:10.1016/j.pan.2016.05.174

Cited by 3 publications

(7 citation statements)

References 42 publications

(63 reference statements)

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“…In this case, the fixed effect and random effect transformation-based methods produce similar estimates for the patient delay: 21 days (95% CI: 21,22) for the fixed effect approach and 25 days (95% CI: 15, 34) for the random effects approach. The MM and WM methods yielded estimates of 14 days (95% CI: 10,20) and 60 days (95% CI: 20, 60), respectively. The large discrepancy between the MM and WM estimates was due to a study with a patient delay of 60 days and comprised approximately 70% of the total number of subjects in the subgroup.…”

Section: Example: Estimating Patient Delay In Pulmonary Tuberculosis mentioning

confidence: 99%

“…Additionally, many systematic reviews or meta‐analyses have attempted to describe or estimate mean or median survival in various disease groups. In these reviews, the primary studies often report median survival (eg, see other studies). Costs represent another often skewed outcome for which medians are often reported in the primary studies, and for which authors of systematic reviews often prefer to present medians given the skewed nature of the data …”

Section: Introductionmentioning

confidence: 99%

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One‐sample aggregate data meta‐analysis of medians

McGrath

Zhao

Qin³

et al. 2018

Statistics in Medicine

106

126

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An aggregate data meta‐analysis is a statistical method that pools the summary statistics of several selected studies to estimate the outcome of interest. When considering a continuous outcome, typically each study must report the same measure of the outcome variable and its spread (eg, the sample mean and its standard error). However, some studies may instead report the median along with various measures of spread. Recently, the task of incorporating medians in meta‐analysis has been achieved by estimating the sample mean and its standard error from each study that reports a median in order to meta‐analyze the means. In this paper, we propose two alternative approaches to meta‐analyze data that instead rely on medians. We systematically compare these approaches via simulation study to each other and to methods that transform the study‐specific medians and spread into sample means and their standard errors. We demonstrate that the proposed median‐based approaches perform better than the transformation‐based approaches, especially when applied to skewed data and data with high inter‐study variance. Finally, we illustrate these approaches in a meta‐analysis of patient delay in tuberculosis diagnosis.

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Section: Example: Estimating Patient Delay In Pulmonary Tuberculosis mentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

One‐sample aggregate data meta‐analysis of medians

McGrath

Zhao

Qin³

et al. 2018

Statistics in Medicine

106

126

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“…Pancreatic ductal adenocarcinoma (PDAC) carries a poor prognosis with an overall 5‐year survival rate of 5%–7%, 1,2 which is amongst the lowest of all malignancies 3 . One of the most important prognostic factors is tumor staging 3,4 ; however, most patients have a metastatic or inoperable disease at the time of diagnosis 1,3 .…”

Section: Introductionmentioning

confidence: 99%

“…Lymph node status is an important prognostic factor, 2,4,5 and it has been found to be an important predictor of long‐term survival after surgery 1,5 . With regard to providing prognostic information, it is not only the number and the ratio of involved lymph nodes that are relevant but also their location 1,6 .…”

Section: Introductionmentioning

confidence: 99%

“…Some studies did not find any significant difference in overall survival (OS) between patients with positive HALN status and those with other positive lymph nodes 5 . However, several others have reported that HALN involvement is associated with reduced survival 2,4,5 and equated the survival disadvantage to those with metastatic disease 4,5,9 . Given the uncertainty regarding the prognostic value of HALN involvement, this study aimed to compare the OS of patients with positive HALN status who underwent surgical resection to patients with hepatic‐only metastatic disease at diagnosis who were treated with modern chemotherapy.…”

Section: Introductionmentioning

confidence: 99%

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Survival impact based on hepatic artery lymph node status in pancreatic adenocarcinoma: A study of patients receiving modern chemotherapy

Perlmutter

Hossain

Naples

et al. 2020

Journal of Surgical Oncology

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BackgroundChemotherapy for pancreatic adenocarcinoma (PDAC) has significantly improved in recent years. While the involvement of the hepatic artery lymph node (HALN; station 8a lymph node) likely represents advanced disease, a comparison to patients with metastases on modern chemotherapy is lacking.MethodsPatients who underwent pancreatoduodenectomy with HALN sent for pathologic review at a single institution from 2003 to 2018 were reviewed. Patients who presented with liver‐only metastases at the time of PDAC diagnosis (Stage IV) and received chemotherapy were identified. Multivariate Cox proportional hazards regression modeling was utilized and overall survival (OS) was estimated using Kaplan–Meier analysis.ResultsOf the 112 patients with a HALN sent for analysis, 17 (15%) were positive and 13 (76%) received chemotherapy. Ninety‐four stage IV patients were identified and were significantly more likely to have received a multiagent rather than single‐agent chemotherapy regimen compared to HALN positive patients (79.8% vs. 38.5%, p < .001). Median OS was significantly longer in all patients who underwent surgical resection, regardless of HALN status, compared to stage IV patients.ConclusionsPatients undergoing pancreatoduodenectomy with HALN positivity have significantly improved OS compared to patients with stage IV disease. HALN involvement does not significantly alter survival among resected patients and does not warrant preoperative endoscopic ultrasound‐guided biopsy.

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