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Showalter TN , Winter KA , Berger AC , Regine WF , Abrams RA , Safran H , Hoffman JP , Benson AB , MacDonald JS , Willett CG
THE INFLUENCE OF TOTAL NODES EXAMINED, NUMBER OF POSITIVE NODES, AND LYMPH NODE RATIO ON SURVIVAL AFTER SURGICAL RESECTION AND ADJUVANT CHEMORADIATION FOR PANCREATIC CANCER: A SECONDARY ANALYSIS OF RTOG 9704
International Journal of Radiation Oncology Biology Physics. 2011 Dec;81(5) :1328-1335
PMID: WOS:000297602400018    PMCID: PMC3038247   
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Abstract
Purpose: Lymph node status is an important predictor of survival in pancreatic cancer. We performed a secondary analysis of Radiation Therapy Oncology Group (RTOG) 9704, an adjuvant chemotherapy and chemoradiation trial, to determine the influence of lymph node factors number of positive nodes (NPN), total nodes examined (TNE), and lymph node ratio (LNR ratio of NPN to TNE) on OS and disease-free survival (DFS). Patient and Methods: Eligible patients from RTOG 9704 form the basis of this secondary analysis of lymph node parameters. Actuarial estimates for OS and DFS were calculated using Kaplan-Meier methods. Cox proportional hazards models were performed to evaluate associations of NPN, TNE, and LNR with OS and DFS. Multivariate Cox proportional hazards models were also performed. Results: There were 538 patients enrolled in the RTOG 9704 trial. Of these, 445 patients were eligible with lymph nodes removed. Overall median NPN was 1 (min-max, 0-18). Increased NPN was associated with worse OS (HR = 1.06, p = 0.001) and DFS (HR = 1.05, p = 0.01). In multivariate analyses, both NPN and TNE were associated with OS and DFS. TNE > 12, and > 15 were associated with increased OS for all patients, but not for node-negative patients (n = 142). Increased LNR was associated with worse OS (HR = 1.01, p < 0.0001) and DES (HR = 1.006, p = 0.002). Conclusion: In patients who undergo surgical resection followed by adjuvant chemoradiation, TNE, NPN, and LNR are associated with OS and DFS. This secondary analysis of a prospective, cooperative group trial supports the influence of these lymph node parameters on outcomes after surgery and adjuvant therapy using contemporary techniques. (C) 2011 Elsevier Inc. RAMS RA, 2006, AM SOC RAD ONC ANN M
Notes
Showalter, Timothy N. Winter, Kathryn A. Berger, Adam C. Regine, William F. Abrams, Ross A. Safran, Howard Hoffman, John P. Benson, Al B. MacDonald, John S. Willett, Christopher G. National Cancer Institute (NCI)[RTOG U10 CA21661, CCOP U10 CA37422, Stat U10 CA32115] Supported by RTOG U10 CA21661, CCOP U10 CA37422, and Stat U10 CA32115 grants from the National Cancer Institute (NCI). This manuscript's contents are the sole responsibility of the authors and do not necessarily represent the official views of the NCI. 41 Elsevier science inc New york 855yo