The More the Better—Lower Rate of Stage Migration and Better Survival in Patients With Retrieval of 20 or More Regional Lymph Nodes in Pancreatic Cancer

Warschkow, René; Widmann, Bernhard; Beutner, Ulrich; Marti, Lukas; Steffen, Thomas; Schiesser, Marc; Schmied, Bruno M.

doi:10.1097/mpa.0000000000000784

Cited by 43 publications

(27 citation statements)

References 46 publications

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“…While the above‐mentioned studies clearly demonstrate the importance of lymphadenectomy for prognostic staging, direct evidence on a therapeutic effect of lymphadenectomy in pancreatic cancer remains limited. An analysis of the SEER database including 7685 patients with stage I and II pancreatic cancer found that retrieval of 20 or more regional lymph nodes was associated with increased survival in node‐negative as well as node‐positive cancers after adjustment for other prognostic factors . While the improved survival with ≥20 retrieved lymph nodes in node‐negative cancers may be explained by effects of stage migration, the improved survival with ≥20 retrieved nodes in node‐positive cancers points to a possible therapeutic effect of radical lymphadenectomy .…”

Section: Extent Of Lymphadenectomy and Outcome In Pancreatic Cancermentioning

confidence: 99%

“…An analysis of the SEER database including 7685 patients with stage I and II pancreatic cancer found that retrieval of 20 or more regional lymph nodes was associated with increased survival in node‐negative as well as node‐positive cancers after adjustment for other prognostic factors . While the improved survival with ≥20 retrieved lymph nodes in node‐negative cancers may be explained by effects of stage migration, the improved survival with ≥20 retrieved nodes in node‐positive cancers points to a possible therapeutic effect of radical lymphadenectomy . In contrast to overall survival, the extent of lymphadenectomy may more directly affect local recurrence and recurrence‐free survival.…”

Section: Extent Of Lymphadenectomy and Outcome In Pancreatic Cancermentioning

confidence: 99%

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Local radicality and survival outcome of pancreatic cancer surgery

Niesen

Hank

Büchler

et al. 2019

Annals of Gastroent Surgery

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Pancreatic cancer remains a therapeutic challenge. Surgical resection in combination with systemic chemotherapy is the only option promising long‐term survival and potential cure. However, only about 20% of patients are diagnosed with tumors that are still in a resectable stage. Even after potentially curative resection and modern regimens for adjuvant chemotherapy, the majority of patients develop local and systemic recurrence resulting in median overall survival times of 28‐54 months. The predominance of systemic recurrence and its impact on survival may lead to the assumption that surgical radicality and local control play only minor roles in the treatment of pancreatic cancer. This review provides an overview of the recent literature on surgical radicality and survival outcome in pancreatic cancer. The current evidence on the extent of lymphadenectomy, the prognostic impact of the extent of lymph node involvement, and the impact of the resection margin status on postresection survival are reviewed. Data from recent studies performed in the context of modern surgery and adjuvant therapy provide good evidence of a considerable impact of local radicality on survival after pancreatic cancer surgery. Surgical techniques that have been developed to refine oncological resections and to increase local control as well as resectability are highlighted. These techniques include artery‐first approaches, level‐3 dissection with removal of the periarterial nerve plexus, the triangle operation, and extended resections. Local radicality and quality of surgical resection remain among the most important parameters that determine the chances for survival in patients with non‐metastatic pancreatic cancer.

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Section: Extent Of Lymphadenectomy and Outcome In Pancreatic Cancermentioning

confidence: 99%

Section: Extent Of Lymphadenectomy and Outcome In Pancreatic Cancermentioning

confidence: 99%

Local radicality and survival outcome of pancreatic cancer surgery

Niesen

Hank

Büchler

et al. 2019

Annals of Gastroent Surgery

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“…A higher ELN count was reportedly associated with a higher PLN count and a decreased risk of false downstaging of the N classification. [ 10 ] Previous evidence has suggested that LNR, which accounts for both the PLN and ELN counts, exhibits prognostic superiority to PLN. [ 17 – 19 ] In this population-based study, we demonstrated significant prognostic heterogeneity within the 8th AJCC N1 and N2 disease after stratified by the rN classification, which verifies the prognostic value of LNR and suggests a room for improvement in the 8th AJCC staging scheme.…”

Section: Discussionmentioning

confidence: 99%

“…[ 6 ] In addition, the total examined lymph node (ELN) count is considered to be of great importance to staging accuracy for pancreatic cancer; that is, an increased number of ELNs is reported to decrease the possibility of stage migration and improves the oncological outcome. [ 10 ] Although the recently launched 8th edition of the AJCC staging scheme for PDAC further divided the N1 classification of the 7th edition into N1 (1–3 PLNs) and N2 (≥4 PLNs), it still did not account for the impact of the ELN on prognostic accuracy. [ 11 ]…”

Section: Introductionmentioning

confidence: 99%

Proposal of a modified American Joint Committee on Cancer staging scheme for resectable pancreatic ductal adenocarcinoma with a lymph node ratio-based N classification

Chen²,

Yuan³

2018

Medicine

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The recently launched 8th edition of the American Joint Committee on Cancer (AJCC) staging scheme for pancreatic ductal adenocarcinoma (PDAC) did not account for the impact of the total examined lymph node count on prognostic accuracy. In this population-based cohort study, we proposed a modified AJCC staging scheme by incorporating a lymph node ratio (LNR)-based N classification for patients with resectable PDAC.We analyzed 8615 patients with resectable PDAC from the Surveillance, Epidemiology, and End Results database between 2004 and 2013. The optimal cut-off points for LNR were identified by recursive partitioning, and an LNR-based N classification was designed accordingly.The LNR-based N classification could further stratify patients with the 8th AJCC N1 and N2 disease into subgroups with significantly different overall survival (P < .001 for both). By replacing the 8th AJCC N classification with the corresponding LNR-based N classification, we further proposed a modified AJCC staging scheme. The modified AJCC staging outperformed the 8th AJCC staging in terms of the discriminatory capacity measured by the concordance index and Akaike information criterion, and the prognostic homogeneity assessed by using the likelihood ratio chi-squared test and stratified survival analysis.Replacing the 8th AJCC N classification with the LNR-based N classification can improve the prognostic performance of the 8th AJCC staging scheme for PDAC.

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“…Nodal status is a potent prognostic factor 6 - 9 . Ignoring total number of examined lymph nodes (eNs), pNs perform well when the number of eNs is more than 20 10 , 11 . Besides, 15 eNs are needed to ensure node-negative status of PDAC 12 .…”

Section: Introductionmentioning

confidence: 99%

A Refined Staging Model for Resectable Pancreatic Ductal Adenocarcinoma Incorporating Examined Lymph Nodes, Location of Tumor and Positive Lymph Nodes Ratio

Song

Chen

et al. 2018

J. Cancer

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Background: Nodal status and tumor site are prognostic factors for resectable pancreatic ductal adenocarcinoma (PDAC). Parameters for nodal status are diverse, and the number of examined lymph nodes (eNs) needed for good prognosis are uncertain. We try to modify staging system of resectable PDAC with parameters mentioned above by recursive partitioning analysis.Methods: Patients from the Surveillance, Epidemiology, and End Results (SEER) database were divided into training cohort and internal validation cohort, randomly. PDAC patients from Sun Yat-sen University Cancer Center were regarded as external validation cohort. The training cohort was used to refine staging model by recursive partitioning analysis, while the internal validation cohort and the external validation cohort were applied to assess discriminatory capacity of staging model. For parameters included in the modified model, their effects were studied.Results: The number of eNs, tumor site and tumor size were risk factors for positive nodal status. Lymph nodes ratio (LNR), tumor site, eNs and T stages of 8th the American Joint Committee on Cancer (AJCC) were selected to develop a refined model, dividing patients into 5 groups of different outcomes, preceding 8th AJCC classification. Besides, we found that (1) for small PDAC (diameter < 1cm), lymph node metastasis was rarely found; (2) enough eNs were needed to ensure better prognosis of node-negative patients; (3) tumors in the head of pancreas were prone to lymph nodes metastasis; (4) for node-positive patients, LNR was a better nodal parameter compared to positive lymph nodes (pNs).Conclusion: Our improved staging system helps to illuminate the interactions among tumor site, size and eNs.

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The More the Better—Lower Rate of Stage Migration and Better Survival in Patients With Retrieval of 20 or More Regional Lymph Nodes in Pancreatic Cancer

Cited by 43 publications

References 46 publications

Local radicality and survival outcome of pancreatic cancer surgery

Local radicality and survival outcome of pancreatic cancer surgery

Proposal of a modified American Joint Committee on Cancer staging scheme for resectable pancreatic ductal adenocarcinoma with a lymph node ratio-based N classification

A Refined Staging Model for Resectable Pancreatic Ductal Adenocarcinoma Incorporating Examined Lymph Nodes, Location of Tumor and Positive Lymph Nodes Ratio

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