2011 SSAT Poster Presentation

Journal of Gastrointestinal Surgery

, Volume 16, Issue 5, pp 920-926

Number of Lymph Nodes Evaluated: Prognostic Value in Pancreatic Adenocarcinoma

  • Marianne HuebnerAffiliated withDepartment of Surgery, Mayo ClinicDepartment of Statistics and Probability, Michigan State UniversityDepartment of Health Sciences Research, Mayo Clinic Email author 
  • , Michael KendrickAffiliated withDepartment of Surgery, Mayo Clinic
  • , Kaye M. Reid-LombardoAffiliated withDepartment of Surgery, Mayo Clinic
  • , Florencia QueAffiliated withDepartment of Surgery, Mayo Clinic
  • , Terry TherneauAffiliated withDepartment of Health Sciences Research, Mayo Clinic
  • , Rui QinAffiliated withDepartment of Health Sciences Research, Mayo Clinic
  • , John DonohueAffiliated withDepartment of Surgery, Mayo Clinic
  • , David NagorneyAffiliated withDepartment of Surgery, Mayo Clinic
  • , Michael FarnellAffiliated withDepartment of Surgery, Mayo Clinic
    • , Michael SarrAffiliated withDepartment of Surgery, Mayo Clinic

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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.

Keywords

Pancreatic cancer Lymph node ratio Cancer specific survival Pathologic staging Lymph node metastasis