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Predictive Performance of Current Nodal Staging Systems in Various Categories of Pancreatic Cancer

  • Pancreatic Tumors
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Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Nodal staging systems (NSS) for pancreatic ductal adenocarcinoma (PDAC) classify patients on the basis of number of metastatic lymph nodes (MLN), metastatic/retrieved lymph node ratio (LNR), and log odds of positive LN (LODDS). The relative prognostic performance of these NSS, however, remains unclear.

Patients and Methods

We identified 2584 patients who underwent surgery for PDAC between 2010 and 2019. Subgroups of each staging system were classified using K-adaptive partitioning method and assessed by comparing time-dependent areas under the curve (AUC) 5 years after surgery.

Results

Patients were subgrouped by MLN (0, 1–3, ≥ 4), LNR (0, 0–0.23, > 0.23), and LODDS (< − 3.5, − 3.5 to – 0.970, > − 0.97). All three NSS were independent prognostic factors for overall survival (OS) and recurrence-free survival (RFS). The AUCs for OS were comparable for the MLN (0.622), LNR (0.609), and LODDS (0.596) systems. Subgroup evaluation based on 12 retrieved lymph nodes (RLN), R1 resection, and extent of resection showed that the AUCs of the MLN and LNR NSS were comparable for OS and RFS regardless of the number of RLNs, R1 resection, and extent of resection. By contrast, the AUCs of the LODDS NSS were lower.

Conclusion

The NSS based on the number of MLN is the best prognostic indicator, with prognostic performance comparable to the other NSS and greater convenience for practical use. This NSS was applicable regardless of the numbers of RLN, R1 resection, and extent of resection.

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Authors and Affiliations

  1. Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, 05505, Republic of Korea

    Woohyung Lee MD, Sarang Hong MD, Yejong Park MD, Bong Jun Kwak MD, PhD, Eunsung Jun MD, PhD, Ki Byung Song MD, PhD, Jae Hoon Lee MD, PhD, Dae Wook Hwang MD, PhD & Song Cheol Kim MD, PhD

  2. Department of Clinical Epidemiology and Biostatistics, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea

    Jung Bok Lee MD, PhD

Authors
  1. Woohyung Lee MD
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  2. Jung Bok Lee MD, PhD
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  3. Sarang Hong MD
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  4. Yejong Park MD
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  5. Bong Jun Kwak MD, PhD
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  6. Eunsung Jun MD, PhD
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  7. Ki Byung Song MD, PhD
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  8. Jae Hoon Lee MD, PhD
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  9. Dae Wook Hwang MD, PhD
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  10. Song Cheol Kim MD, PhD
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Correspondence to Song Cheol Kim MD, PhD.

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Lee, W., Lee, J.B., Hong, S. et al. Predictive Performance of Current Nodal Staging Systems in Various Categories of Pancreatic Cancer. Ann Surg Oncol 29, 390–398 (2022). https://doi.org/10.1245/s10434-021-10641-7

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  • DOI: https://doi.org/10.1245/s10434-021-10641-7

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