Skip to main content
SpringerLink
Log in

Number of Lymph Nodes Evaluated: Prognostic Value in Pancreatic Adenocarcinoma

  • 2011 SSAT Poster Presentation
  • Published:
Journal of Gastrointestinal Surgery Aims and scope

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Huang CM, Lin JX, Zheng CH, et al. Prognostic impact of metastatic lymph node ratio on gastric cancer after curative distal gastrectomy. World J Gastroenterol. 2010; 16: 2055–60.

    Google Scholar 

  2. Schiffman SC, McMasters KM, Scoggins CR, Martin RC, Chagpar AB. Lymph node ratio: a proposed refinement of current axillary staging in breast cancer patients. Journal of the American College of Surgeons. 2011; 213: 45–52.

    Google Scholar 

  3. 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. Techniques in Coloproctology. 2011; 15: 273–9.

    Google Scholar 

  4. Japanese Gastric Cancer Society. Japanese classification of gastric carcinoma: 3rd English edition. Gastric Cancer. 1998; 1: 10–24.

    Google Scholar 

  5. Isaji S, Kawarada Y, Uemoto S. Classification of pancreatic cancer: comparison of Japanese and UICC classifications. Pancreas. 2004; 28: 231–4.

    Article  PubMed  Google Scholar 

  6. Pawlik TM, Abdalla EK, Barnett CC, et al. Feasibility of a randomized trial of extended lymphadenectomy for pancreatic cancer. Arch Surg. 2005; 140: 584–9; discussion 9–91.

    Google Scholar 

  7. Yeo CJ, Cameron JL, Lillemoe KD, et al. Pancreaticoduodenectomy with or without distal gastrectomy and extended retroperitoneal lymphadenectomy for periampullary adenocarcinoma, part 2: randomized controlled trial evaluating survival, morbidity, and mortality. Annals of Surgery. 2002; 236: 355–66; discussion 66–8.

    Google Scholar 

  8. Schwarz RE, Smith DD. Extent of lymph node retrieval and pancreatic cancer survival: information from a large US population database. Annals of Surgical Oncology. 2006; 13: 1189–200.

    Article  PubMed  Google Scholar 

  9. Tomlinson JS, Jain S, Bentrem DJ, et al. Accuracy of staging node-negative pancreas cancer: a potential quality measure. Arch Surg. 2007; 142: 767–23; discussion 73–4.

    Google Scholar 

  10. Schoenleber SJ, Schnelldorfer T, Wood CM, Qin R, Sarr MG, Donohue JH. Factors influencing lymph node recovery from the operative specimen after gastrectomy for gastric adenocarcinoma. J Gastrointest Surg. 2009; 13: 1233–7.

    Article  PubMed  Google Scholar 

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

    Google Scholar 

  12. House MG, Gonen M, Jarnagin WR, 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 

  13. Pawlik TM, Gleisner AL, Cameron JL, et al. Prognostic relevance of lymph node ratio following pancreaticoduodenectomy for pancreatic cancer. Surgery. 2007; 141: 610–8.

    Article  PubMed  Google Scholar 

  14. Riediger H, Keck T, Wellner U, et al. The lymph node ratio is the strongest prognostic factor after resection of pancreatic cancer. J Gastrointest Surg. 2009; 13: 1337–44.

    Article  PubMed  Google Scholar 

  15. 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 

  16. Khan S, Sclabas G, Reid-Lombardo K, et al. Does body mass index/morbid obesity influence outcome in patients who undergo pancreatoduodenectomy for pancreatic adenocarcinoma? J Gastrointest Surg. 14: 1820–5.

  17. Schnelldorfer T, Ware AL, Sarr MG, et al. Long-term survival after pancreatoduodenectomy for pancreatic adenocarcinoma: is cure possible? Annals of surgery. 2008; 247: 456–62.

    Article  PubMed  Google Scholar 

  18. Nitecki SS, Sarr MG, Colby TV, van Heerden JA. Long-term survival after resection for ductal adenocarcinoma of the pancreas. Is it really improving? Annals of surgery. 1995; 221: 59–66.

    Article  PubMed  CAS  Google Scholar 

  19. Gonen M, Schrag D, Weiser MR. Nodal staging score: a tool to assess adequate staging of node-negative colon cancer. J Clin Oncol. 2009; 27: 6166–71.

    Article  PubMed  Google Scholar 

  20. Altman DG, Lausen B, Sauerbrei W, Schumacher M. Dangers of using “optimal” cutpoints in the evaluation of prognostic factors. Journal of the National Cancer Institute. 1994; 86: 829–35.

    Article  PubMed  CAS  Google Scholar 

  21. Contal C, O'Quigley J. An application of changepoint methods in studying the effect of age on survival in breast cancer. Computational Statistics and Data Analysis. 1999; 30: 253–70.

    Article  Google Scholar 

  22. R Development Core Team. R: A language and environment for statistical computing. Vienna, Austria: R Foundation for Statistical Computing 2009.

  23. Vinh-Hung V, Nguyen NP, Cserni G, et al. Prognostic value of nodal ratios in node-positive breast cancer: a compiled update. Future oncology (London, UK). 2009; 5: 1585–603.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA

    Marianne Huebner, Michael Kendrick, Kaye M. Reid-Lombardo, Florencia Que, John Donohue, David Nagorney, Michael Farnell & Michael Sarr

  2. Department of Statistics and Probability, Michigan State University, East Lansing, MI, 48824, USA

    Marianne Huebner

  3. Department of Health Sciences Research, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA

    Marianne Huebner, Terry Therneau & Rui Qin

Authors
  1. Marianne Huebner
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Michael Kendrick
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kaye M. Reid-Lombardo
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Florencia Que
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Terry Therneau
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Rui Qin
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. John Donohue
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. David Nagorney
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Michael Farnell
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Michael Sarr
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Marianne Huebner.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Huebner, M., Kendrick, M., Reid-Lombardo, K.M. et al. Number of Lymph Nodes Evaluated: Prognostic Value in Pancreatic Adenocarcinoma. J Gastrointest Surg 16, 920–926 (2012). https://doi.org/10.1007/s11605-012-1853-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11605-012-1853-2

Keywords

Search

Navigation