Journal of Gastrointestinal Surgery

, Volume 17, Issue 2, pp 257–266 | Cite as

N0/N1, PNL, or LNR? The Effect of Lymph Node Number on Accurate Survival Prediction in Pancreatic Ductal Adenocarcinoma

  • Nakul P. Valsangkar
  • Devon M. Bush
  • James S. Michaelson
  • Cristina R. Ferrone
  • Jennifer A. Wargo
  • Keith D. Lillemoe
  • Carlos Fernández-del Castillo
  • Andrew L. Warshaw
  • Sarah P. ThayerEmail author
2012 SSAT Poster Presentation



We evaluated the prognostic accuracy of LN variables (N0/N1), numbers of positive lymph nodes (PLN), and lymph node ratio (LNR) in the context of the total number of examined lymph nodes (ELN).


Patients from SEER and a single institution (MGH) were reviewed and survival analyses performed in subgroups based on numbers of ELN to calculate excess risk of death (hazard ratio, HR).


In SEER and MGH, higher numbers of ELN improved the overall survival for N0 patients. The prognostic significance (N0/N1) and PLN were too variable as the importance of a single PLN depended on the total number of LN dissected. LNR consistently correlated with survival once a certain number of lymph nodes were dissected (≥13 in SEER and ≥17 in the MGH dataset).


Better survival for N0 patients with increasing ELN likely represents improved staging. PLN have some predictive value but the ELN strongly influence their impact on survival, suggesting the need for a ratio-based classification. LNR strongly correlates with outcome provided that a certain number of lymph nodes is evaluated, suggesting that the prognostic accuracy of any LN variable depends on the total number of ELN.


Pancreatic cancer Lymph node ratio Staging Survival 



We thank Andrew Liss, Ph.D. for his scientific and editorial support. This study was supported by the Andrew L. Warshaw, M.D., Institute for Pancreatic Cancer Research and grants CA117969 and CA127003 from the National Cancer Institute.


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Copyright information

© The Society for Surgery of the Alimentary Tract 2012

Authors and Affiliations

  • Nakul P. Valsangkar
    • 1
  • Devon M. Bush
    • 2
  • James S. Michaelson
    • 2
  • Cristina R. Ferrone
    • 1
  • Jennifer A. Wargo
    • 1
  • Keith D. Lillemoe
    • 1
  • Carlos Fernández-del Castillo
    • 1
  • Andrew L. Warshaw
    • 1
  • Sarah P. Thayer
    • 1
    • 3
    Email author
  1. 1.Department of Surgery and Andrew L. Warshaw, M.D., Institute for Pancreatic Cancer ResearchMassachusetts General Hospital and Harvard Medical SchoolBostonUSA
  2. 2.Laboratory for Quantitative MedicineMassachusetts General Hospital and Harvard Medical SchoolBostonUSA
  3. 3.Pancreatic Biology Laboratory, Department of SurgeryMassachusetts General HospitalBostonUSA

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