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. 2010 Feb;14(2):261-7.
doi: 10.1007/s11605-009-1096-z. Epub 2009 Nov 25.

Does the mechanism of lymph node invasion affect survival in patients with pancreatic ductal adenocarcinoma?

Ioannis T Konstantinidis  1 , Vikram Deshpande, Hui Zheng, Jennifer A Wargo, Carlos Fernandez-del Castillo, Sarah P Thayer, Vasiliki Androutsopoulos, Gregory Y Lauwers, Andrew L Warshaw, Cristina R Ferrone
Affiliations

Does the mechanism of lymph node invasion affect survival in patients with pancreatic ductal adenocarcinoma?

Ioannis T Konstantinidis et al. J Gastrointest Surg. 2010 Feb.

Abstract

Background: Lymph node metastases are prognostically significant in pancreatic ductal adenocarcinoma. Little is known about the significance of direct lymph node invasion.

Aim: The aim of this study is to find out whether direct lymph node invasion has the same prognostic significance as regional nodal metastases.

Methods: Retrospective review of patients resected between 1/1/1993 and 7/31/2008. "Direct" was defined as tumor extension into adjacent nodes, and "regional" was defined as metastases to peripancreatic nodes.

Results: Overall, 517 patients underwent pancreatic resection for adenocarcinoma, of whom 89 had one positive node (direct 26, regional 63), and 79 had two positive nodes (direct 6, regional 68, both 5). Overall, survival of node-negative patients was improved compared to patients with positive nodes (N0 30.8 months vs. N1 16.4 months; p < 0.001). There was no survival difference for patients with direct vs. regional lymph node invasion (p = 0.67). Patients with one positive node had a better overall survival compared to patients with >/=2 positive nodes (22.3 and 15 months, respectively; p < 0.001). The lymph node ratio (+LN/total LN) was prognostically significant after Cox regression (p < 0.001).

Conclusions: Isolated direct invasion occurs in 20% of patients with one to two positive nodes. Node involvement by metastasis or by direct invasion are equally significant predictors of reduced survival. Both the number of positive nodes and the lymph node ratio are significant prognostic factors.

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Figures

Figure 1
Figure 1
In direct invasion (arrowheads) the tumor is directly invading lymph nodes situated in the peripancreatic fat (P pancreas, PF peripancreatic fat, LN lymph node).
Figure 2
Figure 2
Patients with one or two positive nodes have similar survival whether the node is directly invaded by the tumor (A), or is a regional node (B).
Figure 3
Figure 3
Median number of nodes evaluated in patients with positive nodes does not affect survival. A Total number of resected nodes ≥15; B N1 patients with resected nodes <15.
Figure 4
Figure 4
Patients with negative nodes have a better prognosis compared to patients with one, two, or more than two positive nodes.
Figure 5
Figure 5
The influence of LNR on overall survival; A LNR≥0.2; B LNR<0.2.
See this image and copyright information in PMC

References

    1. American Cancer Society. www.cancer.org.
    1. Ferrone CR, Brennan MF, Gonen M, et al. Pancreatic adenocarcinoma: the actual 5-year survivors. J Gastrointest Surg. 2008;12 (4):701–706. - PubMed
    1. Winter JM, Cameron JL, Campbell KA, et al. 1423 pancreaticoduodenectomies for pancreatic cancer: a single-institution experience. J Gastrointest Surg. 2006;10(9):1199–210. discussion 1210–1. - PubMed
    1. Schnelldorfer T, Ware AL, Sarr MG, et al. Long-term survival after pancreatoduodenectomy for pancreatic adenocarcinoma: is cure possible? Ann Surg. 2008;247(3):456–462. - PubMed
    1. Cleary SP, Gryfe R, Guindi M, et al. Prognostic factors in resected pancreatic adenocarcinoma: analysis of actual 5-year survivors. J Am Coll Surg. 2004;198(5):722–731. - PubMed

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