Skip to main content

Advertisement

SpringerLink
Log in

Prognostic Impact of Para-Aortic Lymph Node Micrometastasis in Pancreatic Ductal Adenocarcinoma

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

Abstract

Background

It is still unclear whether micrometastasis of para-aortic lymph nodes (PALNs) in pancreatic ductal adenocarcinoma (PDAC) is tantamount to PALN metastasis detected by hematoxylin and eosin (HE) staining.

Methods

A total of 242 patients with PDAC who underwent radical pancreatectomy with PALN dissection were eligible for this study. Micrometastasis in PALNs was evaluated by CAM 5.2 immunohistochemistry. The relationship between PALN status and overall survival (OS) was analyzed.

Results

Of the 242 enrolled patients, 25 (10 %) had PALN metastasis detected by HE (PALN HE-positive), and 21 (9 %) had PALN micrometastasis not detected by HE but identified by CAM 5.2 immunohistochemistry. Univariate analysis revealed that patients with PALN micrometastasis (p = .004) and PALN HE positivity (p = .003) had a significantly shorter OS than those without PALN metastasis, whereas no significant difference was observed between the two former groups (p = .874). In multivariate analysis, lack of adjuvant chemotherapy (hazard ratio [HR] 2.43, p < .001), PALN micrometastasis (HR 1.89; p = .046), and PALN HE-positivity (HR 1.89, p = .023) were identified as independent risk factors for poor prognosis. Within a subset of 46 patients with PALN HE-positivity or micrometastasis, lack of adjuvant chemotherapy was independently associated with poor OS (HR 2.58. p = .029).

Conclusions

The prognosis of patients with PALN micrometastasis was extremely poor as well as HE-positive PALNs. However, postoperative adjuvant chemotherapy may contribute to improving the prognosis of PDAC patients with PALN metastasis.

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

Similar content being viewed by others

References

  1. Murakami Y, Uemura K, Sudo T, et al. Is pancreatic fistula associated with worse overall survival in patients with pancreatic carcinoma? World J Surg. 2015;39:500–8.

    Article  PubMed  Google Scholar 

  2. Lim JE, Chien MW, Earle CC. Prognostic factors following curative resection for pancreatic adenocarcinoma: a population-based, linked database analysis of 396 patients. Ann Surg. 2003;237:74–85.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Shimada K, Sakamoto Y, Sano T, Kosuge T. The role of paraaortic lymph node involvement on early recurrence and survival after macroscopic curative resection with extended lymphadenectomy for pancreatic carcinoma. J Am Coll Surg. 2006;203:345–52.

    Article  PubMed  Google Scholar 

  4. Murakami Y, Uemura K, Sudo T, et al. Number of metastatic lymph nodes, but not lymph node ratio, is an independent prognostic factor after resection of pancreatic carcinoma. J Am Coll Surg. 2010;211:196–204.

    Article  PubMed  Google Scholar 

  5. Kanda M, Fujii T, Sahin TT, et al. Invasion of the splenic artery is a crucial prognostic factor in carcinoma of the body and tail of the pancreas. Ann Surg. 2010;251:483–7.

    Article  PubMed  Google Scholar 

  6. Nagakawa T, Kobayashi H, Ueno K, et al. Clinical study of lymphatic flow to the paraaortic lymph nodes in carcinoma of the head of the pancreas. Cancer. 1994;73:1155–62.

    Article  CAS  PubMed  Google Scholar 

  7. Kayahara M, Nagakawa T, Ohta T, et al. Analysis of paraaortic lymph node involvement in pancreatic carcinoma: a significant indication for surgery? Cancer. 1999;85:583–90.

    Article  CAS  PubMed  Google Scholar 

  8. Yoshida T, Matsumoto T, Sasaki A, et al. Outcome of paraaortic node-positive pancreatic head and bile duct adenocarcinoma. Am J Surg. 2004;187:736–40.

    Article  PubMed  Google Scholar 

  9. Jiao X, Eslami A, Loffe O, et al. Immunohistochemistry analysis of micrometastasis in pretreatment lymph nodes from patients with esophageal cancer. Ann Thorac Surg. 2003;76:996–1000.

    Article  PubMed  Google Scholar 

  10. Tanabe T, Nishimaki T, Watanabe H, , et al. Immunohistochemically detected micrometastasis in lymph nodes from superficial esophageal squamous cell carcinoma. J Surg Oncol. 2003;82:153–9.

    Article  PubMed  Google Scholar 

  11. Arigami T, Uenosono Y, Yanagita S, et al. Clinical significance of lymph node micrometastasis in gastric cancer. Ann Surg Oncol. 2013;20:515–21.

    Article  PubMed  Google Scholar 

  12. Sonoda H, Tani T. Clinical significance of molecular diagnosis for gastric cancer lymph node micrometastasis. World J Gastroenterol. 2014;20:13728–33.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Bilchik AJ, Hoon DS, Saha S, et al. Prognostic impact of micrometastases in colon cancer: interim results of a prospective multicenter trial. Ann Surg. 2007;246:568–77.

    Article  PubMed  Google Scholar 

  14. Rahbari NN, Bork U, Motschall E, et al. Molecular detection of tumor cells in regional lymph nodes is associated with disease recurrence and poor survival in node-negative colorectal cancer: a systematic review and meta-analysis. J Clin Oncol. 2012;30:60–70.

    Article  PubMed  Google Scholar 

  15. Yonemori A, Kondo S, Matsuno Y, et al. Prognostic impact of para-aortic lymph node micrometastasis in patients with regional node-positive biliary cancer. Br J Surg. 2009;96:509–16.

    Article  CAS  PubMed  Google Scholar 

  16. Yonemori A, Kondo S, Matsuno Y, et al. Prognostic impact of regional lymph node micrometastasis in patients with node-negative biliary cancer. Ann Surg. 2010;252:99–106.

    Article  PubMed  Google Scholar 

  17. Schwarz L, Lupinacci RM, Svrcek M, et al. Para-aortic lymph node sampling in pancreatic head adenocarcinoma. Br J Surg. 2014;101:530–8.

    Article  CAS  PubMed  Google Scholar 

  18. Kayahara M, Funaki K, Tajima H, et al. Surgical implication of micrometastasis for pancreatic cancer. Pancreas. 2010;39:884–8.

    Article  PubMed  Google Scholar 

  19. Kurahara H, Takao S, Maemura K, et al. Impact of lymph node micrometastasis in patients with pancreatic head cancer. World J Surg. 2007;31:483–90.

    Article  PubMed  Google Scholar 

  20. Sobin LH, Gaspodarowicz MK, Wittekind C. International Union Against Cancer (UICC): TNM classification of malignant tumours. 7th ed. New York: Wiley-Blackwell, 2009.

    Google Scholar 

  21. Murakami Y, Uemura K, Sudo T, et al. Adjuvant gemcitabine plus S-1 chemotherapy after surgical resection for pancreatic adenocarcinoma. Am J Surg. 2008;195:757–62.

    Article  CAS  PubMed  Google Scholar 

  22. Murakami Y, Uemura K, Sudo T, et al. Impact of adjuvant gemcitabine plus S-1 chemotherapy after surgical resection for adenocarcinoma of the body or tail of the pancreas. J Gastrointest Surg. 2009;13:85–92.

    Article  PubMed  Google Scholar 

  23. Murakami Y, Uemura K, Sudo T, et al. Long-term results of adjuvant gemcitabine plus S-1 chemotherapy after surgical resection for pancreatic carcinoma. J Surg Oncol. 2012;106:174–80.

    Article  CAS  PubMed  Google Scholar 

  24. Bandyopadhyay S, Basturk O, Coban I, et al. Isolated solitary ducts (naked ducts) in adipose tissue: a specific but underappreciated finding of pancreatic adenocarcinoma and one of the potential reasons of understaging and high recurrence rate. Am J Surg Pathol. 2009;33:425–9.

    Article  PubMed  Google Scholar 

  25. Tol JA, Gouma DJ, Bassi C, et al. Definition of a standard lymphadenectomy in surgery for pancreatic ductal adenocarcinoma: a consensus statement by the International Study Group on Pancreatic Surgery (ISGPS). Surgery. 2014;156:591–600.

    Article  PubMed  Google Scholar 

  26. Egawa S, Toma H, Ohigashi H, et al. Japan Pancreatic Cancer Registry; 30th year anniversary: Japan Pancreas Society. Pancreas. 2012;41:985–92.

    Article  PubMed  Google Scholar 

  27. Ueno H, Ioka T, Ikeda M, et al. Randomized phase III study of gemcitabine plus S-1, S-1 alone, or gemcitabine alone in patients with locally advanced and metastatic pancreatic cancer in Japan and Taiwan: GEST study. J Clin Oncol. 2013;31:1640–8.

    Article  CAS  PubMed  Google Scholar 

  28. Marthey L, Sa-Cunha A, Blanc JF, et al. FOLFIRINOX for locally advanced pancreatic adenocarcinoma: results of an AGEO multicenter prospective observational cohort. Ann Surg Oncol. 2015;22:295–301.

    Article  CAS  PubMed  Google Scholar 

  29. Goldstein D, El-Maraghi RH, Hammel P, et al. nab-Paclitaxel plus gemcitabine for metastatic pancreatic cancer: long-term survival from a phase III trial. J Natl Cancer Inst. 2015;107:1–10.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan

    Toshiaki Komo MD, Yoshiaki Murakami MD, Naru Kondo MD, Kenichiro Uemura MD, Yasushi Hashimoto MD, Naoya Nakagawa MD, Kazuhide Urabe MD, Shinya Takahashi MD & Taijiro Sueda MD

Authors
  1. Toshiaki Komo MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yoshiaki Murakami MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Naru Kondo MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kenichiro Uemura MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yasushi Hashimoto MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Naoya Nakagawa MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Kazuhide Urabe MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Shinya Takahashi MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Taijiro Sueda MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Yoshiaki Murakami MD.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Komo, T., Murakami, Y., Kondo, N. et al. Prognostic Impact of Para-Aortic Lymph Node Micrometastasis in Pancreatic Ductal Adenocarcinoma. Ann Surg Oncol 23, 2019–2027 (2016). https://doi.org/10.1245/s10434-016-5120-8

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-016-5120-8

Keywords

Search

Navigation