Skip to main content

Advertisement

SpringerLink
Log in

Prognostic Value of Metastatic Lymph Node Ratio in Pancreatic Cancer

  • Original Article
  • Published:
Indian Journal of Surgical Oncology Aims and scope Submit manuscript

Abstract

Lymph node involvement in pancreatic adenocancer is one of the strongest predictors of prognosis. However, the extent of lymph node dissection is still a matter of debate and number of dissected nodes varies widely among patients. In order to homogenize this diverse group of patients and more accurately predict their prognosis, we aimed to analyze the effect of metastatic lymph node ratio as an independent prognostic factor. We retrospectively analyzed medical recordings of 326 patients with pancreatic cancer who were treated in a tertiary medical oncology center over a 10-year period. Both in univariate and multivariate analyses, metastatic lymph node ratio proved to be a strong predictor of prognosis which was unaffected from heterogeneity of our patient population and can be used to facilitate predict prognosis of patients who underwent lymph node dissection to various extents and with future studies it can emerge as a successful tool for creating prognostic subgroups of the disease.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Buchler MW, Kleeff J, Friess H (2007) Surgical treatment of pancreatic cancer. J Am Coll Surg 205(4 Suppl):S81–S86. https://doi.org/10.1016/j.jamcollsurg.2007.06.332

    Article  PubMed  Google Scholar 

  2. Loos M, Kleeff J, Friess H, Buchler MW (2008) Surgical treatment of pancreatic cancer. Ann N Y Acad Sci 1138:169–180. https://doi.org/10.1196/annals.1414.024

    Article  PubMed  Google Scholar 

  3. Adams RB, Allen PJ (2009) Surgical treatment of resectable and borderline resectable pancreatic cancer: expert consensus statement by Evans et al. Ann Surg Oncol 16(7):1745–1750. https://doi.org/10.1245/s10434-009-0410-z

    Article  PubMed  Google Scholar 

  4. Schwarz RE, Smith DD (2006) Extent of lymph node retrieval and pancreatic cancer survival: information from a large US population database. Ann Surg Oncol 13(9):1189–1200. https://doi.org/10.1245/s10434-006-9016-x

    Article  PubMed  Google Scholar 

  5. Sperti C, Pasquali C, Piccoli A, Pedrazzoli S (1997) Recurrence after resection for ductal adenocarcinoma of the pancreas. World J Surg 21(2):195–200

    Article  CAS  PubMed  Google Scholar 

  6. Cameron JL, Crist DW, Sitzmann JV, Hruban RH, Boitnott JK, Seidler AJ, Coleman J (1991) Factors influencing survival after pancreaticoduodenectomy for pancreatic cancer. Am J Surg 161(1):120–124 discussion 124-125

    Article  CAS  PubMed  Google Scholar 

  7. Geer RJ, Brennan MF (1993) Prognostic indicators for survival after resection of pancreatic adenocarcinoma. Am J Surg 165(1):68–72 discussion 72-63

    Article  CAS  PubMed  Google Scholar 

  8. Ishikawa O, Ohhigashi H, Sasaki Y, Kabuto T, Fukuda I, Furukawa H, Imaoka S, Iwanaga T (1988) Practical usefulness of lymphatic and connective tissue clearance for the carcinoma of the pancreas head. Ann Surg 208(2):215–220

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Eskander MF, de Geus SW, Kasumova GG, Ng SC, Al-Refaie W, Ayata G, Tseng JF (2016) Evolution and impact of lymph node dissection during pancreaticoduodenectomy for pancreatic cancer. Surgery doi:https://doi.org/10.1016/j.surg.2016.09.032, 161, 968, 976

  10. Pedrazzoli S, DiCarlo V, Dionigi R, Mosca F, Pederzoli P, Pasquali C, Kloppel G, Dhaene K, Michelassi F (1998) Standard versus extended lymphadenectomy associated with pancreatoduodenectomy in the surgical treatment of adenocarcinoma of the head of the pancreas: a multicenter, prospective, randomized study. Lymphadenectomy Study Group. Ann Surg 228(4):508–517

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Yeo CJ, Cameron JL, Lillemoe KD, Sohn TA, Campbell KA, Sauter PK, Coleman J, Abrams RA, Hruban RH (2002) Pancreaticoduodenectomy with or without distal gastrectomy and extended retroperitoneal lymphadenectomy for periampullary adenocarcinoma, part 2: randomized controlled trial evaluating survival, morbidity, and mortality. Ann Surg 236 (3):355–366; discussion 366-358. doi:https://doi.org/10.1097/01.SLA.0000027272.08464.0B

  12. Nimura Y NM, Kato H (2004) Regional versus extended lymph node dissection in radical pancreaticoduodenectomy for pancreatic cancer: a multicenter, prospective, randomized controlled trial HPB 6 (2)

  13. Farnell MB, Pearson RK, Sarr MG, DiMagno EP, Burgart LJ, Dahl TR, Foster N, Sargent DJ (2005) A prospective randomized trial comparing standard pancreatoduodenectomy with pancreatoduodenectomy with extended lymphadenectomy in resectable pancreatic head adenocarcinoma. Surgery 138(4):618–628; discussion 628-630. https://doi.org/10.1016/j.surg.2005.06.044

    Article  PubMed  Google Scholar 

  14. Tol JA, Gouma DJ, Bassi C, Dervenis C, Montorsi M, Adham M, Andren-Sandberg A, Asbun HJ, Bockhorn M, Buchler MW, Conlon KC, Fernandez-Cruz L, Fingerhut A, Friess H, Hartwig W, Izbicki JR, Lillemoe KD, Milicevic MN, Neoptolemos JP, Shrikhande SV, Vollmer CM, Yeo CJ, Charnley RM, International Study Group on Pancreatic S (2014) Definition of a standard lymphadenectomy in surgery for pancreatic ductal adenocarcinoma: a consensus statement by the International Study Group on Pancreatic Surgery (ISGPS). Surgery 156(3):591–600. https://doi.org/10.1016/j.surg.2014.06.016

    Article  PubMed  Google Scholar 

  15. Lee SY, Hwang I, Park YS, Gardner J, Ro JY (2010) Metastatic lymph node ratio in advanced gastric carcinoma: a better prognostic factor than number of metastatic lymph nodes? Int J Oncol 36(6):1461–1467

    PubMed  Google Scholar 

  16. Alatengbaolide LD, Li Y, Xu H, Chen J, Wang B, Liu C, Lu P (2013) Lymph node ratio is an independent prognostic factor in gastric cancer after curative resection (R0) regardless of the examined number of lymph nodes. Am J Clin Oncol 36(4):325–330. https://doi.org/10.1097/COC.0b013e318246b4e9

    Article  CAS  PubMed  Google Scholar 

  17. Zhan HX, Xu JW, Wang L, Zhang GY, Hu SY (2015) Lymph node ratio is an independent prognostic factor for patients after resection of pancreatic cancer. World J Surg Oncol 13:105. https://doi.org/10.1186/s12957-015-0510-0

    Article  PubMed  PubMed Central  Google Scholar 

  18. Berger AC, Watson JC, Ross EA, Hoffman JP (2004) The metastatic/examined lymph node ratio is an important prognostic factor after pancreaticoduodenectomy for pancreatic adenocarcinoma. Am Surg 70 (3):235–240; discussion 240

  19. House MG, Gonen M, Jarnagin WR, D'Angelica M, DeMatteo RP, Fong Y, Brennan MF, Allen PJ (2007) Prognostic significance of pathologic nodal status in patients with resected pancreatic cancer. J Gastrointest Surg 11(11):1549–1555. https://doi.org/10.1007/s11605-007-0243-7

    Article  PubMed  Google Scholar 

  20. Pawlik TM, Gleisner AL, Cameron JL, Winter JM, Assumpcao L, Lillemoe KD, Wolfgang C, Hruban RH, Schulick RD, Yeo CJ, Choti MA (2007) Prognostic relevance of lymph node ratio following pancreaticoduodenectomy for pancreatic cancer. Surgery 141(5):610–618. https://doi.org/10.1016/j.surg.2006.12.013

    Article  PubMed  Google Scholar 

  21. Riediger H, Keck T, Wellner U, zur Hausen A, Adam U, Hopt UT, Makowiec F (2009) The lymph node ratio is the strongest prognostic factor after resection of pancreatic cancer. J Gastrointest Surg 13(7):1337–1344. https://doi.org/10.1007/s11605-009-0919-2

    Article  PubMed  Google Scholar 

  22. Robinson SM, Rahman A, Haugk B, French JJ, Manas DM, Jaques BC, Charnley RM, White SA (2012) Metastatic lymph node ratio as an important prognostic factor in pancreatic ductal adenocarcinoma. Eur J Surg Oncol 38(4):333–339. https://doi.org/10.1016/j.ejso.2011.12.020

    Article  CAS  PubMed  Google Scholar 

  23. Winter JM, Cameron JL, Campbell KA, Arnold MA, Chang DC, Coleman J, Hodgin MB, Sauter PK, Hruban RH, Riall TS, Schulick RD, Choti MA, Lillemoe KD, Yeo CJ (2006) 1423 pancreaticoduodenectomies for pancreatic cancer: a single-institution experience. J Gastrointest Surg 10(9):1199–1210; discussion 1210-1191. https://doi.org/10.1016/j.gassur.2006.08.018

    Article  PubMed  Google Scholar 

  24. Richter A, Niedergethmann M, Sturm JW, Lorenz D, Post S, Trede M (2003) Long-term results of partial pancreaticoduodenectomy for ductal adenocarcinoma of the pancreatic head: 25-year experience. World J Surg 27(3):324–329. https://doi.org/10.1007/s00268-002-6659-z

    Article  PubMed  Google Scholar 

  25. Havenga K, Enker WE, Norstein J, Moriya Y, Heald RJ, van Houwelingen HC, van de Velde CJ (1999) Improved survival and local control after total mesorectal excision or D3 lymphadenectomy in the treatment of primary rectal cancer: an international analysis of 1411 patients. Eur J Surg Oncol 25(4):368–374. https://doi.org/10.1053/ejso.1999.0659

    Article  CAS  PubMed  Google Scholar 

  26. Kodera Y, Schwarz RE, Nakao A (2002) Extended lymph node dissection in gastric carcinoma: where do we stand after the Dutch and British randomized trials? J Am Coll Surg 195(6):855–864

    Article  PubMed  Google Scholar 

  27. Pawlik TM, Abdalla EK, Barnett CC, Ahmad SA, Cleary KR, Vauthey JN, Lee JE, Evans DB, Pisters PW (2005) Feasibility of a randomized trial of extended lymphadenectomy for pancreatic cancer. Arch Surg 140(6):584–589; discussion 589-591. https://doi.org/10.1001/archsurg.140.6.584

    Article  PubMed  Google Scholar 

  28. Valsangkar NP, Bush DM, Michaelson JS, Ferrone CR, Wargo JA, Lillemoe KD, Fernandez-del Castillo C, Warshaw AL, Thayer SP (2013) N0/N1, PNL, or LNR? The effect of lymph node number on accurate survival prediction in pancreatic ductal adenocarcinoma. J Gastrointest Surg 17(2):257–266. https://doi.org/10.1007/s11605-012-1974-7

    Article  PubMed  Google Scholar 

  29. Hellan M, Sun CL, Artinyan A, Mojica-Manosa P, Bhatia S, Ellenhorn JD, Kim J (2008) The impact of lymph node number on survival in patients with lymph node-negative pancreatic cancer. Pancreas 37(1):19–24. https://doi.org/10.1097/MPA.0b013e31816074c9

    Article  PubMed  Google Scholar 

  30. Slidell MB, Chang DC, Cameron JL, Wolfgang C, Herman JM, Schulick RD, Choti MA, Pawlik TM (2008) Impact of total lymph node count and lymph node ratio on staging and survival after pancreatectomy for pancreatic adenocarcinoma: a large, population-based analysis. Ann Surg Oncol 15(1):165–174. https://doi.org/10.1245/s10434-007-9587-1

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of General Surgery, Faculty of Medicine, Izmir University of Economics, İzmir, Turkey

    Can A. Karaca

  2. Izmir Ekonomi Universitesi Sakarya Caddesi, No:156, 35330, Balcova, Izmir, Turkey

    Can A. Karaca

  3. Department of General Surgery, Ege University Faculty of Medicine, Balcova, Izmir, Turkey

    Ahmet Coker

Authors
  1. Can A. Karaca
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ahmet Coker
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Can A. Karaca.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Karaca, C.A., Coker, A. Prognostic Value of Metastatic Lymph Node Ratio in Pancreatic Cancer. Indian J Surg Oncol 10, 50–54 (2019). https://doi.org/10.1007/s13193-018-0824-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13193-018-0824-9

Keywords

Search

Navigation