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Does the Mechanism of Lymph Node Invasion Affect Survival in Patients with Pancreatic Ductal Adenocarcinoma?

  • 2009 SSAT Poster Presentation
  • Published:
Journal of Gastrointestinal Surgery Aims and scope

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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Acknowledgments

We would like to thank Hyacinth Haggarty and Ana Miranda from the Health Information Services and Carol Venuti from the Tumor Registry of the Massachusetts General Hospital for their precious help.

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Authors and Affiliations

  1. Department of Surgery, Massachusetts General Hospital, Boston, MA, USA

    Ioannis T. Konstantinidis, Jennifer A. Wargo, Carlos Fernandez-del Castillo, Sarah P. Thayer, Vasiliki Androutsopoulos, Andrew L. Warshaw & Cristina R. Ferrone

  2. Department of Pathology, Massachusetts General Hospital, Boston, MA, USA

    Vikram Deshpande & Gregory Y. Lauwers

  3. Department of Biostatistics Center, Massachusetts General Hospital, Boston, MA, USA

    Hui Zheng

  4. Wang Ambulatory Care Center 460, 15 Parkman Street, Boston, MA, 02114, USA

    Cristina R. Ferrone

Authors
  1. Ioannis T. Konstantinidis
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  2. Vikram Deshpande
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  3. Hui Zheng
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  4. Jennifer A. Wargo
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  5. Carlos Fernandez-del Castillo
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  6. Sarah P. Thayer
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  7. Vasiliki Androutsopoulos
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  8. Gregory Y. Lauwers
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  9. Andrew L. Warshaw
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  10. Cristina R. Ferrone
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Corresponding author

Correspondence to Cristina R. Ferrone.

Additional information

This research is being supported by the Andrew L. Warshaw, MD Institute for Pancreatic Cancer Research, Boston and by the Lantzounis research grant of the Hellenic Medical Society of New York.

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Konstantinidis, I.T., Deshpande, V., Zheng, H. et al. Does the Mechanism of Lymph Node Invasion Affect Survival in Patients with Pancreatic Ductal Adenocarcinoma?. J Gastrointest Surg 14, 261–267 (2010). https://doi.org/10.1007/s11605-009-1096-z

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  • DOI: https://doi.org/10.1007/s11605-009-1096-z

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