Journal of Gastrointestinal Surgery

, Volume 20, Issue 10, pp 1707–1715

Prognostic Role of Log Odds of Lymph Nodes After Resection of Pancreatic Head Cancer

  • Hartwig Riediger
  • Birte Kulemann
  • Uwe Wittel
  • Ulrich Adam
  • Olivia Sick
  • Hannes Neeff
  • Jens Höppner
  • Ulrich T. Hopt
  • Frank Makowiec
Original Article

Abstract

Introduction

Nodal status is a strong prognostic factor after resection of pancreatic cancer. The lymph node ratio (LNR) has been shown to be superior to the pN status in several studies. The role of log odds of the ratio between positive and negative nodes (LODDS) as a suggested new indicator of prognosis, however, has been hardly evaluated in pancreatic cancer.

Methods

Prognostic factors for overall survival after resection for cancer of the pancreatic head were evaluated in 409 patients from two institutions (prospectively maintained databases). The lymph node status, LNR, and LODDS were separately analyzed and independently compared in multivariate survival analysis.

Results

The median numbers of examined and positive lymph nodes were 16 and 2, respectively. Actuarial 3- and 5-year survival rates were 29 and 16 %. All three classifications of nodal disease significantly predicted survival in the entire group (n = 409), in patients with free resection margins (n = 297), and in patients with <12 examined nodes. In multivariate analysis, however, both LNR and LODDS were equally superior to the nodal status. In node-negative patients (n = 110), LODDS could not identify subgroups with different prognosis.

Conclusion

Both LNR and LODDS are superior to the classical nodal status in predicting prognosis in resected pancreatic cancer. However, LODDS has not shown any advantage over LNR in our series, neither in the entire patient group nor in the subgroups with free margins, negative nodes or a low number of examined nodes. Therefore, the use of LODDS to predict the outcome after resection of pancreatic head cancer cannot be recommended.

Keywords

Pancreatic cancer Resection Survival Prognostic factors Lymph node ratio LogODDS lymph nodes 

References

  1. 1.
    La TM, Cavallini M, Ramacciato G, Cosenza G, Rossi Del MS, Nigri G, Ferri M, Mercantini P, Ziparo V. Role of the lymph node ratio in pancreatic ductal adenocarcinoma. Impact on patient stratification and prognosis. J Surg Oncol 2011;104:629-633.Google Scholar
  2. 2.
    Riediger H, Keck T, Wellner U, zur HA, Adam U, Hopt UT, Makowiec F. The lymph node ratio is the strongest prognostic factor after resection of pancreatic cancer. J Gastrointest Surg 2009;13:1337-1344.Google Scholar
  3. 3.
    Aurello P, Petrucciani N, Nigri GR, La TM, Magistri P, Tierno S, D’Angelo F, Ramacciato G. Log odds of positive lymph nodes (LODDS): what are their role in the prognostic assessment of gastric adenocarcinoma? J Gastrointest Surg 2014;18:1254-1260.CrossRefPubMedGoogle Scholar
  4. 4.
    Persiani R, Cananzi FC, Biondi A, Paliani G, Tufo A, Ferrara F, Vigorita V, D’Ugo D. Log odds of positive lymph nodes in colon cancer: a meaningful ratio-based lymph node classification system. World J Surg 2012;36:667-674.CrossRefPubMedGoogle Scholar
  5. 5.
    Vinh-Hung V, Verschraegen C, Promish DI, Cserni G, Van de Steene J, Tai P, Vlastos G, Voordeckers M, Storme G, Royce M. Ratios of involved nodes in early breast cancer. Breast Cancer Res 2004;6:R680-R688.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    La TM, Nigri G, Petrucciani N, Cavallini M, Aurello P, Cosenza G, Balducci G, Ziparo V, Ramacciato G. Prognostic assessment of different lymph node staging methods for pancreatic cancer with R0 resection: pN staging, lymph node ratio, log odds of positive lymph nodes. Pancreatology 2014;14:289-294.CrossRefGoogle Scholar
  7. 7.
    Riediger H, Adam U, Utzolino S, Neeff HP, Hopt UT, Makowiec F. Perioperative outcome after pancreatic head resection: a 10-year series of a specialized surgeon in a university hospital and a community hospital. J Gastrointest Surg 2014;18:1434-1440.CrossRefPubMedGoogle Scholar
  8. 8.
    Adam U, Makowiec F, Riediger H, Benz S, Liebe S, Hopt UT. [Pancreatic leakage after pancreas resection. An analysis of 345 operated patients]. Chirurg 2002;73:466-473.CrossRefPubMedGoogle Scholar
  9. 9.
    Boeck S, Ankerst DP, Heinemann V. The role of adjuvant chemotherapy for patients with resected pancreatic cancer: systematic review of randomized controlled trials and meta-analysis. Oncology 2007;72:314-321.CrossRefPubMedGoogle Scholar
  10. 10.
    Oettle H, Post S, Neuhaus P, Gellert K, Langrehr J, Ridwelski K, Schramm H, Fahlke J, Zuelke C, Burkart C, Gutberlet K, Kettner E, Schmalenberg H, Weigang-Koehler K, Bechstein WO, Niedergethmann M, Schmidt-Wolf I, Roll L, Doerken B, Riess H. Adjuvant chemotherapy with gemcitabine vs observation in patients undergoing curative-intent resection of pancreatic cancer: a randomized controlled trial. JAMA 2007;297:267-277.CrossRefPubMedGoogle Scholar
  11. 11.
    Winter JM, Cameron JL, Campbell KA, Arnold MA, Chang DC, Coleman J, Hodgin MB, Sauter PK, Hruban RH, Riall TS, Schulick RD, Choti MA, Lillemoe KD, Yeo CJ. 1423 pancreaticoduodenectomies for pancreatic cancer: A single-institution experience. J Gastrointest Surg 2006;10:1199-1210.CrossRefPubMedGoogle Scholar
  12. 12.
    Yamamoto T, Yagi S, Kinoshita H, Sakamoto Y, Okada K, Uryuhara K, Morimoto T, Kaihara S, Hosotani R. Long-term survival after resection of pancreatic cancer: a single-center retrospective analysis. World J Gastroenterol 2015;21:262-268.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Strobel O, Hinz U, Gluth A, Hank T, Hackert T, Bergmann F, Werner J, Buchler MW. Pancreatic adenocarcinoma: number of positive nodes allows to distinguish several N categories. Ann Surg 2015;261:961-969.CrossRefPubMedGoogle Scholar
  14. 14.
    Arslan NC, Sokmen S, Canda AE, Terzi C, Sarioglu S. The prognostic impact of the log odds of positive lymph nodes in colon cancer. Colorectal Dis 2014;16:O386-O392.CrossRefPubMedGoogle Scholar
  15. 15.
    Sun Z, Xu Y, Li dM, Wang ZN, Zhu GL, Huang BJ, Li K, Xu HM. Log odds of positive lymph nodes: a novel prognostic indicator superior to the number-based and the ratio-based N category for gastric cancer patients with R0 resection. Cancer 2010;116:2571-2580.Google Scholar
  16. 16.
    Calero A, Escrig-Sos J, Mingol F, Arroyo A, Martinez-Ramos D, de JM, Salvador-Sanchis JL, Garcia-Granero E, Calpena R, Lacueva FJ. Usefulness of the log odds of positive lymph nodes to predict and discriminate prognosis in gastric carcinomas. J Gastrointest Surg 2015;19:813-820.Google Scholar
  17. 17.
    Wang J, Hassett JM, Dayton MT, Kulaylat MN. The prognostic superiority of log odds of positive lymph nodes in stage III colon cancer. J Gastrointest Surg 2008;12:1790-1796.CrossRefPubMedGoogle Scholar

Copyright information

© The Society for Surgery of the Alimentary Tract 2016

Authors and Affiliations

  1. 1.Department of SurgeryUniversity of FreiburgFreiburgGermany
  2. 2.Department of SurgeryBerlinGermany

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