Prognostic Significance of Lymph Node Metastasis and Micrometastasis Along the Left Side of Superior Mesenteric Artery in Pancreatic Head Cancer
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Backgrounds and Objectives
Although metastasis in lymph nodes along the left side of superior mesenteric artery (SMA-LNs-lt) is sometimes found, survival benefit of SMA-LN-lt dissection for pancreatic head cancer is still unclear. The purpose of this study is to evaluate the prognostic significance of SMA-LN-lt metastasis and micrometastasis.
A total of 166 patients with pancreatic head cancer who underwent pancreatectomy with lymphadenectomy including SMA-LNs-lt between 2002 and 2017 were reviewed retrospectively. Micrometastasis was evaluated by immunohistochemistry.
Twenty patients (12%) had SMA-LN-lt metastasis detected by hematoxylin and eosin (HE) staining, and eight patients (5%) had micrometastasis. Patients with SMA-LN-lt HE-positive or micrometastasis group experienced significantly shorter overall survival (OS) than those without (p = .015). In multivariate analysis, SMA-LN-lt HE-positive or micrometastasis (p = .034), portal vein resection (p = .002), histologic grade 2/3 (p = .046), LN metastasis (p = .002), and lack of adjuvant chemotherapy (p < .001) were independent risk factors. Within a subset of SMA-LN-lt HE-positive or micrometastasis group, lack of adjuvant chemotherapy (p = .003) was the independent poor prognostic factor.
In pancreatic head cancer, the rate of SMA-LN-lt HE-positive and micrometastasis was found in 12% and 5%, respectively. Adjuvant chemotherapy may contribute to improvement of prognosis in patients with LN metastasis including SMA-LN-lt metastasis and micrometastasis.
KeywordsPancreatic head cancer Superior mesenteric artery Lymph node metastasis Micrometastasis Adjuvant chemotherapy
Study concepts: Kenjiro Okada, Yoshiaki Murakami, Naru Kondo, Kenichiro Uemura, Naoya Nakagawa, Shingo Seo, Shinya Takahashi, and Taijiro Sueda.
Study design: Kenjiro Okada, Yoshiaki Murakami, Naru Kondo, Kenichiro Uemura, Naoya Nakagawa.
Data acquisition: Kenjiro Okada, Yoshiaki Murakami, Naru Kondo, Kenichiro Uemura, Naoya Nakagawa, Shingo Seo.
Quality control of data and algorithms: Yoshiaki Murakami, Naru Kondo, Kenichiro Uemura.
Data analysis and interpretation: Kenjiro Okada, Yoshiaki Murakami, Naru Kondo, Kenichiro Uemura, Naoya Nakagawa, Shingo Seo.
Statistical analysis: Kenjiro Okada, Yoshiaki Murakami, Naru Kondo, Kenichiro Uemura, Naoya Nakagawa.
Manuscript preparation: Kenjiro Okada, Yoshiaki Murakami, Naru Kondo, Kenichiro Uemura, Naoya Nakagawa.
Manuscript editing: Yoshiaki Murakami, Naru Kondo, Kenichiro Uemura.
Manuscript review: Kenjiro Okada, Yoshiaki Murakami, Naru Kondo.
Compliance with Ethical Standards
The study protocol and informed consent form were consistent with the recommendations of the Declaration of Helsinki and approved by the Institutional Review Board of Hiroshima University.
Conflict of Interest
The authors declare that they have no conflict of interest.
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