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Prognostic Relevance of Number and Ratio of Metastatic Lymph Nodes in Resected Pancreatic, Ampullary, and Distal Bile Duct Carcinomas
Annals of Surgical Oncology, 08/20/2012
Pomianowska E et al. – The predictive value of nodal involvement depends on the type of cancer within the pancreatic head. In AC and DBC, N status adequately discriminates between good and poor prognosis. In PC, LNR may be more powerful in prognostic subclassification.
Methods- They included 179 consecutive pancreatoduodenectomies for PC, AC, or DBC, and performed standardized histopathologic evaluation, including prospective registration and retrospective reevaluation of the cancer origin.
- Associations between histopathologic variables and LNR, N status, and number of metastatic nodes were evaluated.
- Unadjusted and adjusted survival analysis was performed.
- Overall 5 year survival was 6 % for PC (n = 72), 26 % for DBC (n = 46), and 46 % for AC (n = 61).
- Lymph node involvement was more frequent in PC (75 %) than in AC (48 %) and DBC (57 %).
- In PC, N status did not discriminate between prognostic groups (N1 vs. N0; p = 0.31).
- However, increasing LNR was associated with poorer survival in unadjusted analysis, as well as when adjusting for margin involvement, degree of differentiation, and tumor diameter (p = 0.032; hazard ratio 1.87, 95 % confidence interval 1.06–3.31).
- In AC and DBC, N status clearly discriminated between subgroups of patients with different long–term survival in unadjusted and adjusted survival analysis (N1 vs. N0; p < 0.001), whereas number of metastatic nodes and LNR did not predict survival among node–positive resections.
