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Prognostic Significance of Lymph Node Metastases in Pancreatic Head Cancer Treated with Extended Lymphadenectomy: Not Just a Matter of Numbers

  • Pancreatic Tumors
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Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The prognostic significance of variables related to nodal involvement (node status, number of disease-positive nodes [posNn], node ratio [Nr], and site of nodal metastases) in patients with resected pancreatic head cancer remains poorly defined.

Methods

Clinical, operative, and pathologic data, including indexes of the burden and extent of nodal involvement, were analyzed in a consecutive series of 77 patients who underwent resection with extended lymphadenectomy for adenocarcinoma of the pancreatic head.

Results

Fifty-nine patients (77%) were found to have lymph node (LN) metastases. Median LN count, posNn, and Nr were 28 (10–54), 4 (1–29), and 14% (2%–55%), respectively. Twenty-six patients (44% of N1) had metastases limited to node level (NL) 1 (i.e., peripancreatic nodes); metastases up to NL2 (nodes along main arteries and hepatic hilum) and NL3 (preaortic nodes) were found in 21 (36%) and 12 (20%) patients, respectively. Interestingly, survival of patients with positive LN limited to NL1 was similar to that of node-negative patients (P = 0.407). posNn, Nr, and NL were all significant predictors of survival (P < 0.015). posNn and Nr proved to be an accurate proxy of NL involvement. The best cutoff of posNn was 2 and of and Nr was 10%.

Conclusions

The level of nodal metastatic spread is a statistically significant prognostic factor in cancer of the pancreatic head. Both posNn and Nr are accurate proxy of NL and may improve patients’ risk stratification.

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References

  1. Denoix PF. Enquete permanent dans les centres antercancereux. Bull Inst Natl Hyg. 1946;1:70.

    Google Scholar 

  2. Rizk N, Venkatraman E, Park B, Flores R, Bains MS, Rusch V. American Joint Committee on Cancer staging system. The prognostic importance of the number of involved lymph nodes in esophageal cancer: implications for revisions of the American Joint Committee on Cancer staging system. J Thorac Cardiovasc Surg. 2006;132:1374–81.

    Article  PubMed  Google Scholar 

  3. Gu Y, Swisher SG, Ajani JA, Correa AM, Hofstetter WL, Liao Z, et al. The number of lymph nodes with metastasis predicts survival in patients with esophageal or esophagogastric junction adenocarcinoma who receive preoperative chemoradiation. Cancer. 2006;106:1017–25.

    Article  PubMed  Google Scholar 

  4. Karpeh MS, Leon L, Klimstra D, Brennan MF. Lymph node staging in gastric cancer: is location more important than Number? An analysis of 1,038 patients. Ann Surg. 2000;232:362–71.

    Article  CAS  PubMed  Google Scholar 

  5. Le Voyer TE, Sigurdson ER, Hanlon AL, Macdonald JS, Catalano PJ, Haller DG. Colon cancer survival is associated with increasing number of lymph nodes analyzed: a secondary survey of intergroup trial INT-0089. J Clin Oncol. 2003;21:2912–9.

    Article  PubMed  Google Scholar 

  6. Endo I, Shimada H, Tanabe M, Fujii Y, Takeda K, Morioka D, et al. Prognostic significance of the number of positive lymph nodes in gallbladder cancer. J Gastrointest Surg. 2006;10:999–1007.

    Article  PubMed  Google Scholar 

  7. Nakagawa T, Kamiyama T, Kurauchi N, Matsushita M, Nakanishi K, Kamachi H, et al. Number of lymph node metastases is a significant prognostic factor in intrahepatic cholangiocarcinoma. World J Surg. 2005;29:728–33.

    Article  PubMed  Google Scholar 

  8. Hong SM, Cho H, Lee OJ, Ro JY. The number of metastatic lymph nodes in extrahepatic bile duct carcinoma as a prognostic factor. Am J Surg Pathol. 2005;29:1177–83.

    Article  PubMed  Google Scholar 

  9. Sakata J, Shirai Y, Wakai T, Yokoyama N, Sakata E, Akazawa K, et al. Number of positive lymph nodes independently affects long-term survival after resection in patients with ampullary carcinoma. Eur J Surg Oncol. 2007;33:346–51.

    Article  CAS  PubMed  Google Scholar 

  10. Schwarz RE, Smith DD. Extent of lymph node retrieval and pancreatic cancer survival: information from a large US population database. Ann Surg Oncol. 2006;13:1189–200.

    Article  PubMed  Google Scholar 

  11. House MG, Gönen M, Jarnagin WR, D’Angelica M, DeMatteo RP, Fong Y, et al. Prognostic significance of pathologic nodal status in patients with resected pancreatic cancer. J Gastrointest Surg. 2007;11:1549–55.

    Article  PubMed  Google Scholar 

  12. Sobin LH, Wittekind C. TNM classification of malignant tumours. 6th ed. New York: Wiley (2002).

    Google Scholar 

  13. Wang J, Hassett JM, Dayton MT, Kulaylat MN. Lymph node ratio: role in the staging of node-positive colon cancer. Ann Surg Oncol. 2008;15:1600–8.

    Article  PubMed  Google Scholar 

  14. Marchet A, Mocellin S, Ambrosi A, Morgagni P, Garcea D, Marrelli D, et al. The ratio between metastatic and examined lymph nodes (N ratio) is an independent prognostic factor in gastric cancer regardless of the type of lymphadenectomy: results from an Italian multicentric study in 1853 patients. Ann Surg. 2007;245:543–52.

    Article  PubMed  Google Scholar 

  15. Slidell MB, Chang DC, Cameron JL, Wolfgang C, Herman JM, Schulick RD, et al. Impact of total lymph node count and lymph node ratio on staging and survival after pancreatectomy for pancreatic adenocarcinoma: a large, population-based analysis. Ann Surg Oncol. 2008;15:165–74.

    Article  PubMed  Google Scholar 

  16. Japanese Research Society for Gastric Cancer. General rules for gastric cancer study in surgery and pathology. Jpn J Surg. 1981;11:127–39.

    Article  Google Scholar 

  17. Saito H, Fukumoto Y, Osaki T, Yamada Y, Fukuda K, Tatebe S, et al. Pognostic significance of level and number of lymph node metastases in patients with gastric cancer. Ann Surg Oncol. 2007;14:1688–93.

    Article  PubMed  Google Scholar 

  18. Hida J, Okuno K, Yasutomi M, Yoshifuji T, Matsuzaki T, Uchida T, et al. Number versus distribution in classifying regional lymph node metastases from colon cancer. J Am Coll Surg. 2005;201:217–22.

    Article  PubMed  Google Scholar 

  19. Capussotti L, Massucco P, Ribero D, Viganò L, Muratore A, Calgaro M, et al. Extended lymphadenectomy and vein resection for pancreatic head cancer: outcomes and implications for therapy. Arch Surg. 2003;138:1316–22.

    Article  PubMed  Google Scholar 

  20. Japan Pancreas Society. Classification of pancreatic carcinoma. 2nd English edn. Kanehara, Tokyo (2003).

  21. Pawlik TM, Abdalla EK, Barnett CC, Ahmad SA, Cleary KR, Vauthey JN, et al. Feasibility of a randomized trial of extended lymphadenectomy for pancreatic cancer. Arch Surg. 2005;140:584–9.

    Article  PubMed  Google Scholar 

  22. Asiyanbola B, Gleisner A, Herman JM, Choti MA, Wolfgang CL, Swartz M, et al. Determining pattern of recurrence following pancreaticoduodenectomy and adjuvant 5-flurouracil-based chemoradiation therapy: effect of number of metastatic lymph nodes and lymph node ratio. J Gastrointest Surg. 2009;13:752–9.

    Article  PubMed  Google Scholar 

  23. Berger AC, Watson JC, Ross EA, Hoffman JP. The metastatic/examined lymph node ratio is an important prognostic factor after pancreaticoduodenectomy for pancreatic adenocarcinoma. Am Surg. 2004;70:235–40.

    PubMed  Google Scholar 

  24. Pawlik TM, Gleisner AL, Cameron JL, Winter JM, Assumpcao L, Lillemoe KD, et al. Prognostic relevance of lymph node ratio following pancreaticoduodenectomy for pancreatic cancer. Surgery. 2007;141:610–8.

    Article  PubMed  Google Scholar 

  25. Sierzega M, Popiela T, Kulig J, Nowak K. The ratio of metastatic/resected lymph nodes is an independent prognostic factor in patients with node-positive pancreatic head cancer. Pancreas. 2006;33:240–5.

    Article  PubMed  Google Scholar 

  26. Falconi M, Crippa S, Domínguez I, Barugola G, Capelli P, Marcucci S, et al. Prognostic relevance of lymph node ratio and number of resected nodes after curative resection of ampulla of Vater carcinoma. Ann Surg Oncol. 2008;15:3178–318.

    Article  PubMed  Google Scholar 

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Correspondence to Paolo Massucco MD.

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Paolo Massucco and Dario Ribero contributed equally to this article.

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Massucco, P., Ribero, D., Sgotto, E. et al. Prognostic Significance of Lymph Node Metastases in Pancreatic Head Cancer Treated with Extended Lymphadenectomy: Not Just a Matter of Numbers. Ann Surg Oncol 16, 3323–3332 (2009). https://doi.org/10.1245/s10434-009-0672-5

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  • DOI: https://doi.org/10.1245/s10434-009-0672-5

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