Role of lymphadenectomy, adjuvant chemotherapy, and treatment at high-volume centers in patients with resected pancreatic cancer—a distinct view on lymph node yield

Warschkow, René; Tsai, Catherine; Köhn, Nastassja; Erdem, Suna; Schmied, Bruno M.; Nussbaum, Daniel P.; Gloor, Beat; Müller, Sascha; Blazer, Dan G.; Worni, Mathias

doi:10.1007/s00423-020-01859-2

Cited by 14 publications

(4 citation statements)

References 52 publications

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“…Mitsuka et al (2020) found that the median survival time was significantly improved for patients diagnosed between 44 and 83 years old who underwent liver resection or pancreatectomy. Other study (Warschkow et al, 2020) showed that lymphadenectomy had only 18% direct effect on improved overall survival, while 82% of its effect were mediated by other factors like treatment at high-volume hospitals and adjuvant chemotherapy for patients whose median age were 66 years. However, the analysis on differences among different ages of patients is scarce.…”

Section: Discussionmentioning

confidence: 97%

Prognostic Factors of Survival in Pancreatic Cancer Metastasis to Liver at Different Ages of Diagnosis: A SEER Population-Based Cohort Study

2021

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Background: Liver is a common metastatic organ for most malignancies, especially the pancreas. However, evidence for prognostic factors of pancreatic cancer metastasis to the liver at different ages is lacking. Thus, we aimed to evaluate the predictors of patients with pancreatic cancer metastasis to liver grouped by age of diagnosis.Methods: We chose the patients diagnosed between 2004 and 2015 from the SEER database. The primary lesions of metastatic liver cancer between sexes were compared using the Pearson’s chi-square test for categorical variables. The overall survival (OS) and cancer-specific survival (CSS) were the endpoint of the study. The prognostic factors were analyzed with the Kaplan-Meier method and log-rank test, and Cox proportional-hazards regression model.Results: The main primary sites of metastatic liver cancer for our patients are lung and brunchu, sigmoid colon, pancreas, which in males are lung and bronchu, sigmoid colon and pancreas, while breast, lung and bronchu, sigmoid colon in females. Furthermore, we explored the prognostic factors of pancreatic cancer metastasis to liver grouped by age at diagnosis. Tumor grade, histology and treatment are valid prognostic factors in all age groups. Additionally, gender and AJCC N stage in age<52 years old, while race and AJCC N stage in age >69 years old were predictors. Surgery alone was the optimal treatment in group age>69 years old, whereas surgery combined with chemotherapy was the best option in the other groups.Conclusion: Our study evaluated the predictors of patients with pancreatic cancer metastasis to liver at various ages of diagnosis.

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Section: Discussionmentioning

confidence: 97%

Prognostic Factors of Survival in Pancreatic Cancer Metastasis to Liver at Different Ages of Diagnosis: A SEER Population-Based Cohort Study

2021

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“…This analysis was used to quantify the fraction of direct and indirect effects of the observed association between age and RS. It was differentiated between how much of the observed effect of age on RS is caused by age itself (direct effect) and how much of the observed effect of age on RS is caused by other characteristics (indirect effects) [35]. In this analysis, multivariable additive regression trees with a Bernoulli distribution were used to model nonlinear relationships, hierarchical data structures, and a mixture of continuous and categorical variables while fully including interrelationships between the data.…”

Section: Discussionmentioning

confidence: 99%

The Impact of Age in the Treatment of Non‐comorbid Patients with Rectal Cancer: Survival Outcomes from the National Cancer Database

et al. 2023

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Background Multimodal therapy has improved survival outcomes for rectal cancer (RC) significantly with an exemption for older patients. We sought to assess whether older non-comorbid patients receive substandard oncological treatment for localized RC referring to the National Comprehensive Cancer Network (NCCN) guidelines and whether it affects survival outcomes. Methods This is a retrospective study using patient data from the National Cancer Data Base (NCDB) for histologically confirmed RC from 2002 to 2014. Non-comorbid patients between C50 and B85 years and defined treatment for localized RC were included and assigned to a younger (\75 years) and an older group (C75 years). Treatment approaches and their impact on relative survival (RS) were analyzed using loess regression models and compared between both groups. Furthermore, mediation analysis was performed to measure the independent relative effect on age and other variables on RS. Data were assessed using the Strengthening the Reporting of Observational studies in Epidemiology (STROBE) checklist. Results Of 59,769 included patients, 48,389 (81.0%) were assigned to the younger group (\75 years). Oncologic resection was performed in 79.6% of the younger patients compared to 67.2% of the older patients (p \ 0.001). Chemotherapy (74.3% vs. 56.1%) and radiotherapy (72.0% vs. 58.1%) were provided less often in older patients, respectively (p \ 0.001). Increasing age was associated with enhanced 30-and 90-day mortality with 0.6% and 1.1% in the younger and 2.0% and 4.1% in the elderly group (p \ 0.001) and worse RS rates [multivariable adjusted HR: 1.93 (95% CI 1.87-2.00), p \ 0.001]. Adherence to standard oncological therapy resulted in a significant increase in 5-year RS (multivariable adjusted HR: 0.80 (95% CI 0.74-0.86), p \ 0.001). Mediation analysis revealed that RS was mainly affected by age itself (84%) rather than the choice of therapy. Conclusions The likelihood to receive substandard oncological therapy increases in the older population and negatively affects RS. Since age itself has a major impact on RS, better patient selection should be performed to identify those that are potentially eligible for standard oncological care regardless of their age.

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“…Surgical resection constitutes the therapeutic cornerstone in PDAC. Among factors that interact with the postoperative oncologic outcome such as chemotherapy and tumor size, lymph node (LN) status also plays a decisive role as a predictor of survival [ 3 , 4 ]. Currently, the Tumor Node Metastasis (TNM) classification by the American Joint Committee on Cancer (AJCC) and the Union for International Cancer Control (UICC) is the most commonly used classification system worldwide [ 5 , 6 ].…”

Section: Introductionmentioning

confidence: 99%

N, LNR or LODDS: Which Is the Most Appropriate Lymph Node Classification Scheme for Patients with Radically Resected Pancreatic Cancer?

Prassas

Safi

Stylianidi

et al. 2022

Cancers

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Background: Even though numerous novel lymph node (LN) classification schemes exist, an extensive comparison of their performance in patients with resected pancreatic ductal adenocarcinoma (PDAC) has not yet been performed. Method: We investigated the prognostic performance and discriminative ability of 25 different LN ratio (LNR) and 27 log odds of metastatic LN (LODDS) classifications by means of Cox regression and C-statistic in 319 patients with resected PDAC. Regression models were adjusted for age, sex, T category, grading, localization, presence of metastatic disease, positivity of resection margins, and neoadjuvant therapy. Results: Both LNR or LODDS as continuous variables were associated with advanced tumor stage, distant metastasis, positive resection margins, and PDAC of the head or corpus. Two distinct LN classifications, one LODDS and one LNR, were found to be superior to the N category in the complete patient collective. However, only the LODDS classification exhibited statistically significant, gradually increasing HRs of their subcategories and at the same time significantly higher discriminative potential in the subgroups of patients with PDAC of the head or corpus and in patients with tumor free resection margins or M0 status, respectively. On this basis, we built a clinically helpful nomogram to estimate the prognosis of patients after radically resected PDAC. Conclusion: One LNR and one LODDS classification scheme were found to out-perform the N category in terms of both prognostic performance and discriminative ability, in distinct patient subgroups, with reference to OS in patients with resected PDAC.

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Role of lymphadenectomy, adjuvant chemotherapy, and treatment at high-volume centers in patients with resected pancreatic cancer—a distinct view on lymph node yield

Cited by 14 publications

References 52 publications

Prognostic Factors of Survival in Pancreatic Cancer Metastasis to Liver at Different Ages of Diagnosis: A SEER Population-Based Cohort Study

Prognostic Factors of Survival in Pancreatic Cancer Metastasis to Liver at Different Ages of Diagnosis: A SEER Population-Based Cohort Study

The Impact of Age in the Treatment of Non‐comorbid Patients with Rectal Cancer: Survival Outcomes from the National Cancer Database

N, LNR or LODDS: Which Is the Most Appropriate Lymph Node Classification Scheme for Patients with Radically Resected Pancreatic Cancer?

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