Pawlik TM, Gleisner AL, Cameron JL, et al.. Prognostic relevance of lymph node ratio following pancreaticoduodenectomy for pancreatic cancer. Surgery. 141: 610-618

Johns Hopkins University, Baltimore, Maryland, United States
Surgery (Impact Factor: 3.38). 05/2007; 141(5):610-8. DOI: 10.1016/j.surg.2006.12.013
Source: PubMed


The presence or absence of lymph node metastases is known to be an important prognostic factor for patients with pancreatic cancer. Few studies have investigated the ratio of the number of lymph nodes harboring metastatic cancer to the total number of lymph nodes examined (lymph node ratio [LNR]) with regard to outcome after pancreaticoduodenectomy for ductal cancer of the pancreas.
Between 1995 and 2005, a total of 905 patients underwent pancreaticoduodenectomy for pancreatic adenocarcinoma. Demographics, operative data, number of lymph nodes evaluated, number of lymph nodes with metastatic carcinoma, LNR, pathologic margin status, and long-term survival were analyzed.
There were 187 (20.7%) of the 905 patients who had negative peripancreatic lymph nodes (N0), whereas 718 (79.3%) of the 905 patients had lymph node metastases (N1). The median number of lymph nodes evaluated in the N0 group was 15 versus 18 in the N1 group (P = .12). At median follow-up of 24 months, the median survival for all patients was 17.4 months, and the 5-year actuarial survival rate was 16.1%. Patients with lymph node metastases had a shorter median overall survival (16.5 months) compared with patients with negative lymph nodes (25.3 months; P = .001). Compared with the total number of lymph nodes examined or total number of lymph node metastases, LNR was the most compelling predictor of survival. As the LNR increased, median overall survival decreased (LNR = 0, 25.3 months; LNR > 0 to 0.2, 21.7 months; LNR > 0.2 to 0.4, 15.3 months; LNR > 0.4, 12.2 months; P = .001). After adjusting for other factors associated with survival, LNR remained an independent predictor of overall survival (P < .001).
After pancreaticoduodenectomy for adenocarcinoma of the pancreas, LNR was one of the most powerful predictors of survival. LNR should be considered when stratifying patients in future clinical trials.

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    • "However, a significant association between the LNR and survival for patients with pancreatic cancer was identified in separate studies [6, 23–25]. Furthermore, using data from patients undergoing pancreaticoduodenectomy for pancreatic adenocarcinoma, the LNR has been shown to be one of the most powerful predictors of short-and long-term survival [25] and has been suggested as a new tool for stratifying patients in future trials [6]. Thus, beyond the qualitative LN status (positive or negative nodes), the LNR may provide a quantitative tool that improves the current classification system for periampullary tumors [7] [26]. "
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    ABSTRACT: . Several histopathologic features of periampullary tumors have been shown to be correlated with prognosis. We evaluated their association with mortality at multiple time points. Methods . A retrospective chart review identified 207 patients with periampullary adenocarcinomas who underwent pancreaticoduodenectomy between January 1, 2001 and December 31, 2009. Clinicopathologic features were assessed, and the data were analyzed using univariate and multivariate methods. Results. In univariate analysis, perineural invasion had a strong association with 1-year mortality (OR 3.03, CI 1.42–6.47), and one lymph node (LN) increase in the LN ratio (LNR) equated with a 5-fold increase in mortality. In contrast, LN status (OR 6.42, CI 3.32–12.41) and perineural invasion (OR 5.44, CI 2.81–10.52) had the strongest associations with mortality at 3 years. Using Cox proportional hazards, perineural invasion (HR 2.61, CI 1.77–3.85) and LN status (HR 2.69, CI 1.84–3.95) had robust associations with overall mortality. Recursive partitioning analysis identified LNR as the most important risk factor for mortality at 1 and 3 years. Conclusions. Overall mortality was closely related to the LNR within the first year, while longer follow-up periods demonstrated a stronger association with perineural invasion and overall LN status. Therefore, the current staging for periampullary tumors may need to be updated to include the LNR.
    HPB Surgery 07/2014; 2014(5):890530. DOI:10.1155/2014/890530
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    • "It has been widely documented in the literature that lymph node status is one of the most important independent prognostic factors of survival, in particular, for resectable cases. Studies have found that the number of positive lymph nodes [27] [28], lymph node ratios (number of lymph nodes involved to number of lymph nodes examined ) [29] [30] [31] [32], and site of lymph node metastases [33] [34] [35] [36] may be more powerful predictors of postoperative survival than simple lymph node status (e.g., negative or positive). A recent surgical study has found that the number of lymph nodes examined affects, albeit differently , the prognostic accuracy of the number of positive nodes and the lymph node ratio [37]. "
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    ABSTRACT: The objective of this study is to assess lymphotropic nanoparticle-enhanced magnetic resonance imaging (LNMRI) in identifying malignant nodal involvement in patients with pancreatic ductal adenocarcinoma. Magnetic resonance imaging was performed in 13 patients with known or high index of suspicion of pancreatic cancer and who were scheduled for surgical resection. Protocols included T2*-weighted imaging before and after administration of Ferumoxytol (Feraheme) for the evaluation of lymph node involvement. Eleven of the 13 patients underwent a Whipple procedure and lymph node dissection. Nodes that lacked contrast uptake were deemed malignant, and those that demonstrated homogeneous uptake were deemed benign. A total of 264 lymph nodes were resection, of which 17 were malignant. The sensitivity and specificity of LNMRI was 76.5% and 98.4% at a nodal level and 83.3% and 80% at a patient level. LNMRI demonstrated high sensitivity and specificity in patients with pancreatic ductal adenocarcinoma.
    Translational oncology 12/2013; 6(6):670-5. DOI:10.1593/tlo.13400 · 2.88 Impact Factor
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    • "Le Voyer et al. [14] analyzed data from patients with stage II and III colon cancer, and reported that the lymph node ratio (LNR) was an important prognostic factor even after adjusting for other parameters such as tumor stage, grade, and histology. Marchet et al. [18] and Pawlik et al. [19] also demonstrated that LNR was an independent predictor of survival in gastric cancer and pancreas cancer, respectively. "
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    ABSTRACT: It is increasingly being recognized that the lymph node ratio (LNR) is an important prognostic factor for gallbladder carcinoma patients. The present study evaluated predictors of tumor recurrence and survival in a large, mono-institutional cohort of patients who underwent surgical resection for gallbladder carcinoma, focusing specifically on the prognostic value of lymph node (LN) status and of LNR in stage IIIB patients. Between 2004 and 2011, 123 patients who underwent R0 radical resection for gallbladder carcinoma at the Chonnam National University Hwasun Hospital were reviewed retrospectively. Patients were staged according to the American Joint Committee on Cancer 7th edition, and prognostic factors affecting disease free survival, such as age, sex, comorbidity, body mass index, presence of preoperative symptoms, perioperative blood transfusion, postoperative complications, LN dissection, tumor size, differentiation, lymph-vascular invasion, perineural invasion, T stage, presence of LN involvement, N stage, numbers of positive LNs, LNR and implementation of adjuvant chemotherapy, were statistically analyzed. LN status was an important prognostic factor in patients undergoing curative resection for gallbladder carcinoma. The total number of LNs examined was implicated with prognosis, especially in N0 patients. LNR was a powerful predictor of disease free survival even after controlling for competing risk factors, in curative resected gallbladder cancer patients, and especially in stage IIIB patients. LNR is confirmed as an independent prognostic factor in curative resected gallbladder cancer patients, especially in stage IIIB gallbladder carcinoma.
    Journal of the Korean Surgical Society 03/2013; 84(3):168-77. DOI:10.4174/jkss.2013.84.3.168 · 0.73 Impact Factor
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