Number of Lymph Nodes Evaluated: Prognostic Value in Pancreatic Adenocarcinoma

Overview

Journal J Gastrointest Surg

Specialty Gastroenterology

Date 2012 Mar 17

PMID 22421988

Citations 59

Authors

Marianne Huebner

Michael Kendrick

Kaye M Reid-Lombardo

Florencia Que

Terry Therneau

Rui Qin

John Donohue

David Nagorney

Michael Farnell

Michael Sarr

Affiliations

Soon will be listed here.

Abstract

Introduction: The impact of the number of lymph node (LN) evaluated pathologically on accurate staging is unknown. Our primary aim was to determine a minimum number of evaluated LN needed to provide accurate staging of pancreatic cancer.

Methods: Four hundred ninety-nine patients underwent a curative pancreatectomy for pancreatic adenocarcinoma cancer from 1981-2007. The probability of understaging a patient as N0 was estimated based on the number of LN evaluated. The prognostic value of LN ratio (LNR) was assessed.

Results: Survival for node-negative (pN0) patients with <11 LN examined was worse than for pN0 patients with ≥11 LNs with a hazard ratio (95 % CI) of 1.33 (1.1-1.7, p = 0.01) with 3-year survivals of 32 vs. 50%, respectively. Three-year survival for pN1 patients with <11 nodes evaluated was similar to pN1 patients with ≥11 nodes (25 vs. 30%). LNR ≥ 0.17 predicted worse survival with hazard ratio of 1.76 (1.3-2.4, p = 0.001) than LNR < 0.17; 3-year survivals were 37 vs. 19%.

Conclusion: Patients with "N0" disease with <11 LN evaluated pathologically have worse survival, suggesting that metastatic nodes were missed by evaluating too few nodes. For pN1 patients, LNR stratifies survival of patient cohorts more accurately. Adequate staging of pancreatic cancer requires pathologic evaluation of ≥11 LNs.

Citing Articles

Prognostic significance of three lymph node staging systems in pancreatic cancer with ≤ 12 and > 12 retrieved lymph nodes.

Zheng Y, Li R, Xu J, Shi H, Xing C, Li Z Updates Surg. 2025; .

PMID: 39794683 DOI: 10.1007/s13304-025-02075-7.

The Association between Sampling and Survival in Patients with Pancreatic Ductal Adenocarcinoma Who Received Neoadjuvant Therapy and Pancreaticoduodenectomy.

Taherian M, Katz M, Prakash L, Wei D, Tong Y, Lai Z Cancers (Basel). 2024; 16(19.

PMID: 39409932 PMC: 11476037. DOI: 10.3390/cancers16193312.

ASO Practice Guidelines Series: Management of Resectable, Borderline Resectable, and Locally Advanced Pancreas Cancer.

Turner K, Wilson G, Patel S, Ahmad S Ann Surg Oncol. 2023; 31(3):1884-1897.

PMID: 37980709 DOI: 10.1245/s10434-023-14585-y.

Exploration of the lymphadenectomy strategy for elderly pancreatic ductal adenocarcinoma patients undergoing curative-intent resection.

Li Z, Zhang X, Guo C, Sun C, Li Z, Fei H Am J Cancer Res. 2023; 13(5):1938-1951.

PMID: 37293173 PMC: 10244123.

Role of adjuvant chemotherapy on recurrence and survival in patients with resected ampulla of Vater carcinoma.

Park S, Shin K, Kim I, Hong T, Kim Y, Lee M World J Gastrointest Oncol. 2023; 15(4):677-688.

PMID: 37123060 PMC: 10134206. DOI: 10.4251/wjgo.v15.i4.677.

References

Vinh-Hung V, Nguyen N, Cserni G, Truong P, Woodward W, Verkooijen H . Prognostic value of nodal ratios in node-positive breast cancer: a compiled update. Future Oncol. 2009; 5(10):1585-603. DOI: 10.2217/fon.09.129. View

Gonen M, Schrag D, Weiser M . Nodal staging score: a tool to assess adequate staging of node-negative colon cancer. J Clin Oncol. 2009; 27(36):6166-71. PMC: 3651597. DOI: 10.1200/JCO.2009.23.7958. View

Schiffman S, McMasters K, Scoggins C, Martin R, Chagpar A . Lymph node ratio: a proposed refinement of current axillary staging in breast cancer patients. J Am Coll Surg. 2011; 213(1):45-52. DOI: 10.1016/j.jamcollsurg.2011.04.024. View

Riediger H, Keck T, Wellner U, Zur Hausen A, Adam U, Hopt U . The lymph node ratio is the strongest prognostic factor after resection of pancreatic cancer. J Gastrointest Surg. 2009; 13(7):1337-44. DOI: 10.1007/s11605-009-0919-2. View

Schnelldorfer T, Ware A, Sarr M, Smyrk T, Zhang L, Qin R . Long-term survival after pancreatoduodenectomy for pancreatic adenocarcinoma: is cure possible?. Ann Surg. 2008; 247(3):456-62. DOI: 10.1097/SLA.0b013e3181613142. View

Khan S, Sclabas G, Reid-Lombardo K, Sarr M, Nagorney D, Kendrick M . Does body mass index/morbid obesity influence outcome in patients who undergo pancreatoduodenectomy for pancreatic adenocarcinoma?. J Gastrointest Surg. 2010; 14(11):1820-5. DOI: 10.1007/s11605-010-1285-9. View

Tomlinson J, Jain S, Bentrem D, Sekeris E, Maggard M, Hines O . Accuracy of staging node-negative pancreas cancer: a potential quality measure. Arch Surg. 2007; 142(8):767-723. DOI: 10.1001/archsurg.142.8.767. View

House M, Gonen M, Jarnagin W, DAngelica M, DeMatteo R, Fong Y . Prognostic significance of pathologic nodal status in patients with resected pancreatic cancer. J Gastrointest Surg. 2007; 11(11):1549-55. DOI: 10.1007/s11605-007-0243-7. View

Huang C, Lin J, Zheng C, Li P, Xie J, Lin B . Prognostic impact of metastatic lymph node ratio on gastric cancer after curative distal gastrectomy. World J Gastroenterol. 2010; 16(16):2055-60. PMC: 2860085. DOI: 10.3748/wjg.v16.i16.2055. View

10.

Japanese Gastric Cancer Association . Japanese Classification of Gastric Carcinoma - 2nd English Edition -. Gastric Cancer. 2002; 1(1):10-24. DOI: 10.1007/s101209800016. View

11.

Greenberg R, Itah R, Ghinea R, Sacham-Shmueli E, Inbar R, Avital S . Metastatic lymph node ratio (LNR) as a prognostic variable in colorectal cancer patients undergoing laparoscopic resection. Tech Coloproctol. 2011; 15(3):273-9. DOI: 10.1007/s10151-011-0701-9. View

12.

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(3):240-5. DOI: 10.1097/01.mpa.0000235306.96486.2a. View

13.

Berger A, Watson J, Ross E, Hoffman J . The metastatic/examined lymph node ratio is an important prognostic factor after pancreaticoduodenectomy for pancreatic adenocarcinoma. Am Surg. 2004; 70(3):235-40. View

14.

Isaji S, Kawarada Y, Uemoto S . Classification of pancreatic cancer: comparison of Japanese and UICC classifications. Pancreas. 2004; 28(3):231-4. DOI: 10.1097/00006676-200404000-00003. View

15.

Nitecki S, Sarr M, Colby T, Van Heerden J . Long-term survival after resection for ductal adenocarcinoma of the pancreas. Is it really improving?. Ann Surg. 1995; 221(1):59-66. PMC: 1234495. DOI: 10.1097/00000658-199501000-00007. View

16.

Altman D, Lausen B, Sauerbrei W, Schumacher M . Dangers of using "optimal" cutpoints in the evaluation of prognostic factors. J Natl Cancer Inst. 1994; 86(11):829-35. DOI: 10.1093/jnci/86.11.829. View

17.

Yeo C, Cameron J, Lillemoe K, Sohn T, Campbell K, Sauter P . Pancreaticoduodenectomy with or without distal gastrectomy and extended retroperitoneal lymphadenectomy for periampullary adenocarcinoma, part 2: randomized controlled trial evaluating survival, morbidity, and mortality. Ann Surg. 2002; 236(3):355-66; discussion 366-8. PMC: 1422589. DOI: 10.1097/00000658-200209000-00012. View

18.

Schwarz R, Smith D . Extent of lymph node retrieval and pancreatic cancer survival: information from a large US population database. Ann Surg Oncol. 2006; 13(9):1189-200. DOI: 10.1245/s10434-006-9016-x. View

19.

Pawlik T, Abdalla E, Barnett C, Ahmad S, Cleary K, Vauthey J . Feasibility of a randomized trial of extended lymphadenectomy for pancreatic cancer. Arch Surg. 2005; 140(6):584-9. DOI: 10.1001/archsurg.140.6.584. View

20.

Pawlik T, Gleisner A, Cameron J, Winter J, Assumpcao L, Lillemoe K . Prognostic relevance of lymph node ratio following pancreaticoduodenectomy for pancreatic cancer. Surgery. 2007; 141(5):610-8. DOI: 10.1016/j.surg.2006.12.013. View