Lymph node ratio as valuable predictor in pancreatic cancer treated with R0 resection and adjuvant treatment

You, Min Su; Choi, Yong‐Kook; Shin, Benjamin J.; Paik, Woo Hyun; Ryu, Ji Kon; Kim, Yong Tae; Jang, Dong Kee; Kwon, Wooil; Jang, Jin Young; Kim, Sun Whe

doi:10.1186/s12885-019-6193-0

Cited by 40 publications

(29 citation statements)

References 25 publications

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“…Pooled analysis of our data demonstrated better survival in patients with low LNR as compared to a high value. We have mainly used an LNR of 0.2 as a cut-off, which has been validated in several studies [2][3][4]7,[9][10][11][12][13][14][15][16]. The low heterogeneity in our studies further makes the result more noteworthy.…”

Section: Discussionmentioning

confidence: 97%

“…Prognostic impact of lymph nodal metastasis can be assessed by using various methods such as the presence of positive LNs, total number of LNs, ratio of positive to total LNs, and also ratio of positive to negative LNs [7]. It should be noted that considering the number of positive LN involved to categorize nodal disease and to predict prognosis has been inaccurate.…”

Section: Introductionmentioning

confidence: 99%

“…In recent times, LN ratio (LNR) is being evaluated as a prognostic indicator in several of the published studies apart from just using the number of positive LN [2][3][4][7][8][9][10][11][12][13][14][15][16][17][18]. The LNR is defined as the ratio of metastatic to the total number of harvested LNs, and it has emerged as an indicator of cancer-specific survival in recent years.…”

Section: Introductionmentioning

confidence: 99%

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Lymph Node Ratio as a Prognostic Marker in Pancreatic Cancer Survival: A Systematic Review and Meta-Analysis

Karjol

Chandranath

Jonnada

et al. 2020

Cureus

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The lymph node ratio (LNR) is defined as the ratio of number of positive lymph nodes to the total number of lymph nodes harvested during surgery. The objective of this article is to investigate the efficacy of LNR as a prognostic indicator of survival in pancreatic cancer patients who have undergone surgery by meta-analysis. Methods A systematic database search was performed in MEDLINE, Embase, and Google Scholar for relevant studies that reported LNR in pancreatic cancer. Two authors independently screened the relevant articles for selection and to extract data. All studies published in English up to April 2020 were obtained, and a total of 17,128 node-positive patients in 14 studies were included in this meta-analysis. RevMan software 5.3 (Cochrane Collaboration, the Nordic Cochrane Centre, Copenhagen, Denmark) was used for conducting all statistical analyses. Results This meta-analysis demonstrated that LNR > 0.2 significantly correlated with worse survival (hazard ratio [HR]: 1.84; 95% CI: 1.74-1.94; p ≤ 0.00001) in node-positive pancreatic cancer patients. Conclusions Our findings have demonstrated that a higher LNR is a predictor of poor survival and that LNR serves as an independent prognostic marker for assessing survival using a cutoff of 20%.

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Section: Discussionmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Lymph Node Ratio as a Prognostic Marker in Pancreatic Cancer Survival: A Systematic Review and Meta-Analysis

Karjol

Chandranath

Jonnada

et al. 2020

Cureus

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“…With continuous improvements in detection methods, the number of lymph nodes and the positive lymph node ratio (pLNR) as the bases for lymph node staging have attracted increasing attention. In addition, the pLNR has been shown to predict the prognosis of patients with pancreatic cancer (8), breast cancer (9), and laryngeal squamous cell carcinoma (10).…”

Section: Introductionmentioning

confidence: 99%

The Positive Lymph Node Ratio Predicts Survival in T1−4N1−3M0 Non-Small Cell Lung Cancer: A Nomogram Using the SEER Database

2020

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Background: An increasing number of studies have shown that the positive lymph node ratio (pLNR) can be used to evaluate the prognosis of non-small cell lung cancer (NSCLC) patients. To determine the predictive value of the pLNR, we collected data from the Surveillance, Epidemiology, and End Results (SEER) database and performed a retrospective analysis. Methods: We collected survival and clinical information on patients with T 1−4 N 1−3 M 0 NSCLC diagnosed between 2010 and 2016 from the SEER database and screened them according to inclusion and exclusion criteria. X-tile software was used to obtain the best cutoff value for the pLNR. Then, we randomly divided patients into a training set and a validation set at a ratio of 7:3. Pearson's correlation coefficient, tolerance and the variance inflation factor (VIF) were used to detect collinearity between variables. Univariate and multivariate Cox regression analyses were used to identify significant prognostic factors, and nomograms was constructed to visualize the results. The concordance index (C-index), calibration curves, and decision curve analysis (DCA) were used to assess the predictive ability of the nomogram. We divided the patient scores into four groups according to the interquartile interval and constructed a survival curve using Kaplan-Meier analysis. Results: A total of 6,245 patients were initially enrolled. The best cutoff value for the pLNR was determined to be 0.55. The nomogram contained 13 prognostic factors, including the pLNR. The pLNR was identified as an independent prognostic factor for both overall survival (OS) and cancer-specific survival (CSS). The C-index was 0.703 (95% CI, 0.695-0.711) in the training set and 0.711 (95% CI, 0.699-0.723) in the validation set. The calibration curves and DCA also indicated the good predictability of the nomogram. Risk stratification revealed a statistically significant difference among the four groups of patients divided according to quartiles of risk score. Conclusion: The nomogram containing the pLNR can accurately predict survival in patients with T 1−4 N 1−3 M 0 NSCLC.

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“…Based on longitudinal studies, we know that margin negative (R0) resection for pancreatic cancer translates into improved survival 14 – 16 . In addition, increased number of lymph nodes retrieved during surgery frequently allows accurate staging and is synonymous with the adequacy of surgical resection 17 . There are currently several studies that also reports improved resection margin with the use of robotic platforms 12 .…”

Section: Introductionmentioning

confidence: 99%

Robotic pancreaticoduodenectomy provides better histopathological outcomes as compared to its open counterpart: a meta-analysis

Dong

Felsenreich

Gogna

et al. 2021

Sci Rep

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The aim of this meta-analysis was to evaluate whether robotic pancreaticoduodenectomy (PD) may provide better clinical and pathologic outcomes compared to its open counterpart. The Pubmed, EMBASE, and Cochrane Library were systematically searched. Overall postoperative morbidity and resection margin involvement rate were the primary endpoints. Secondary endpoints included operating time, estimated blood loss (EBL), incisional surgical site infection (SSI) rate, length of hospital stay (LOS), and number of lymph nodes harvested. Twenty-four studies totaling 12,579 patients (2,175 robotic PD and 10,404 open PD were included. Overall postoperative mortality did not significantly differ [OR (95%CI) = 0.86 (0.74, 1.01); p = 0.06]. Resection margin involvement rate was significantly lower in robotic PD [15.6% vs. 19.9%; OR (95%CI) = 0.64 (0.41, 1.00); p = 0.05; NNT = 23]. Operating time was significantly longer in robotic PD [MD (95%CI) = 75.17 (48.05, 102.28); p < 0.00001]. EBL was significantly decreased in robotic PD [MD (95%CI) = − 191.35 (− 238.12, − 144.59); p < 0.00001]. Number of lymph nodes harvested was significantly higher in robotic PD [MD (95%CI) = 2.88 (1.12, 4.65); p = 0.001]. This meta-analysis found that robotic PD provides better histopathological outcomes as compared to open PD at the cost of longer operating time. Furthermore, robotic PD did not have any detrimental impact on clinical outcomes, with lower wound infection rates.

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Lymph node ratio as valuable predictor in pancreatic cancer treated with R0 resection and adjuvant treatment

Cited by 40 publications

References 25 publications

Lymph Node Ratio as a Prognostic Marker in Pancreatic Cancer Survival: A Systematic Review and Meta-Analysis

Lymph Node Ratio as a Prognostic Marker in Pancreatic Cancer Survival: A Systematic Review and Meta-Analysis

The Positive Lymph Node Ratio Predicts Survival in T1−4N1−3M0 Non-Small Cell Lung Cancer: A Nomogram Using the SEER Database

Robotic pancreaticoduodenectomy provides better histopathological outcomes as compared to its open counterpart: a meta-analysis

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