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Berger AC , Watson JC , Ross EA , Hoffman JP
The metastatic/examined lymph node ratio is an important prognostic factor after pancreaticoduodenectomy for pancreatic adenocarcinoma
American Surgeon. 2004 Mar;70(3) :235-240
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Survival after curative resection for pancreatic adenocarcinoma remains poor, an important prognostic factor is lymph node (LN) status. Recent reports have established the number of LN examined as a separate prognostic factor in many malignancies. We retrospectively reviewed the charts of 128 patients undergoing pancreaticoduodenectomy (PD) for pancreatic cancer and obtained information such as overall survival (OS), disease-free survival (DFS), tumor characteristics, preoperative carbohydrate antigen (CA) 19-9, sex, and age. The ratio of metastatic to examined LN (LNR) was determined, and OS and DFS were analyzed in relation to the three groups: LNR = 0, LNR < 0.15, and LNR > 0.15. The median number of LN collected was 17. There were 46 N0 patients (median = 12) and 83 N1 patients (median = 19). The number of LN harvested had no impact on OS or DFS in the NO or NI patient populations. When LNR was examined as a continuous variable, it had a borderline impact on OS (P = 0.06! 8). Examination of LNR by three groups showed an impact on OS (P = 0.037) and DFS (P = 0.013). After curative PD for pancreatic cancer, the ratio of metastatic to examined lymph nodes is an important prognostic factor and should be evaluated in stratification schemes for future clinical trials investigating adjuvant treatments.
English Article KeyWords Plus: GASTRIC-CARCINOMA; CANCER; NUMBER; LYMPHADENECTOMY; STATISTICS; SURVIVAL; IMPACT Berger, AC; *Fox* *Chase* Canc Ctr, Dept Surg Oncol, 330 Cottman Ave, Philadelphia, PA 19111 USA. Research Addresses: *Fox* *Chase* Canc Ctr, Dept Surg Oncol, Philadelphia, PA 19111 USA. *Fox* *Chase* Canc Ctr, Div Biostat, Philadelphia, PA 19111 USA. Cited References: *AM JOINT COMM CAN, 1997, AJCC STAG MAN BANDO E, 2002, ANN SURG ONCOL, V9, P775 BENASSAI G, 1999, J EXP CLIN CANC RES, V18, P23 FEINSTEIN AR, 1985, NEW ENGL J MED, V312, P1604 GAJRA A, 2003, J CLIN ONCOL, V21, P1029 GEBHARDT C, 2000, LANGENBECK ARCH SURG, V385, P14 GERVASONI JE, 2000, SURG CLIN N AM, V80, P1631 HERR HW, 2002, J UROLOGY, V167, P1295 INOUE K, 2002, ANN SURG ONCOL, V9, P27 JEMAL A, 2003, CA-CANCER J CLIN, V53, P5 LEVOYER TE, 2003, J CLIN ONCOL, V21, P2912 LIM JE, 2003, ANN SURG, V237, P74 SIERRA A, 2003, ANN SURG ONCOL, V10, P219 TEPPER JE, 2001, J CLIN ONCOL, V19, P157 WEIR L, 2002, J CLIN ONCOL, V20, P1793 Number of cited references: 15 Number of times cited: 0 Publisher: SOUTHEASTERN SURGICAL CONGRESS; 141 WEST WIEUCA RD, STE B100, ATLANTA, GA 30342 USA. 0003-1348