Advertisement

Annals of Surgical Oncology

, Volume 23, Issue 6, pp 2019–2027 | Cite as

Prognostic Impact of Para-Aortic Lymph Node Micrometastasis in Pancreatic Ductal Adenocarcinoma

  • Toshiaki Komo
  • Yoshiaki Murakami
  • Naru Kondo
  • Kenichiro Uemura
  • Yasushi Hashimoto
  • Naoya Nakagawa
  • Kazuhide Urabe
  • Shinya Takahashi
  • Taijiro Sueda
Pancreatic Tumors

Abstract

Background

It is still unclear whether micrometastasis of para-aortic lymph nodes (PALNs) in pancreatic ductal adenocarcinoma (PDAC) is tantamount to PALN metastasis detected by hematoxylin and eosin (HE) staining.

Methods

A total of 242 patients with PDAC who underwent radical pancreatectomy with PALN dissection were eligible for this study. Micrometastasis in PALNs was evaluated by CAM 5.2 immunohistochemistry. The relationship between PALN status and overall survival (OS) was analyzed.

Results

Of the 242 enrolled patients, 25 (10 %) had PALN metastasis detected by HE (PALN HE-positive), and 21 (9 %) had PALN micrometastasis not detected by HE but identified by CAM 5.2 immunohistochemistry. Univariate analysis revealed that patients with PALN micrometastasis (p = .004) and PALN HE positivity (p = .003) had a significantly shorter OS than those without PALN metastasis, whereas no significant difference was observed between the two former groups (p = .874). In multivariate analysis, lack of adjuvant chemotherapy (hazard ratio [HR] 2.43, p < .001), PALN micrometastasis (HR 1.89; p = .046), and PALN HE-positivity (HR 1.89, p = .023) were identified as independent risk factors for poor prognosis. Within a subset of 46 patients with PALN HE-positivity or micrometastasis, lack of adjuvant chemotherapy was independently associated with poor OS (HR 2.58. p = .029).

Conclusions

The prognosis of patients with PALN micrometastasis was extremely poor as well as HE-positive PALNs. However, postoperative adjuvant chemotherapy may contribute to improving the prognosis of PDAC patients with PALN metastasis.

Keywords

Overall Survival Gemcitabine Pancreatic Ductal Adenocarcinoma Biliary Tract Cancer Regional Lymph Node Metastasis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Murakami Y, Uemura K, Sudo T, et al. Is pancreatic fistula associated with worse overall survival in patients with pancreatic carcinoma? World J Surg. 2015;39:500–8.CrossRefPubMedGoogle Scholar
  2. 2.
    Lim JE, Chien MW, Earle CC. Prognostic factors following curative resection for pancreatic adenocarcinoma: a population-based, linked database analysis of 396 patients. Ann Surg. 2003;237:74–85.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Shimada K, Sakamoto Y, Sano T, Kosuge T. The role of paraaortic lymph node involvement on early recurrence and survival after macroscopic curative resection with extended lymphadenectomy for pancreatic carcinoma. J Am Coll Surg. 2006;203:345–52.CrossRefPubMedGoogle Scholar
  4. 4.
    Murakami Y, Uemura K, Sudo T, et al. Number of metastatic lymph nodes, but not lymph node ratio, is an independent prognostic factor after resection of pancreatic carcinoma. J Am Coll Surg. 2010;211:196–204.CrossRefPubMedGoogle Scholar
  5. 5.
    Kanda M, Fujii T, Sahin TT, et al. Invasion of the splenic artery is a crucial prognostic factor in carcinoma of the body and tail of the pancreas. Ann Surg. 2010;251:483–7.CrossRefPubMedGoogle Scholar
  6. 6.
    Nagakawa T, Kobayashi H, Ueno K, et al. Clinical study of lymphatic flow to the paraaortic lymph nodes in carcinoma of the head of the pancreas. Cancer. 1994;73:1155–62.CrossRefPubMedGoogle Scholar
  7. 7.
    Kayahara M, Nagakawa T, Ohta T, et al. Analysis of paraaortic lymph node involvement in pancreatic carcinoma: a significant indication for surgery? Cancer. 1999;85:583–90.CrossRefPubMedGoogle Scholar
  8. 8.
    Yoshida T, Matsumoto T, Sasaki A, et al. Outcome of paraaortic node-positive pancreatic head and bile duct adenocarcinoma. Am J Surg. 2004;187:736–40.CrossRefPubMedGoogle Scholar
  9. 9.
    Jiao X, Eslami A, Loffe O, et al. Immunohistochemistry analysis of micrometastasis in pretreatment lymph nodes from patients with esophageal cancer. Ann Thorac Surg. 2003;76:996–1000.CrossRefPubMedGoogle Scholar
  10. 10.
    Tanabe T, Nishimaki T, Watanabe H, , et al. Immunohistochemically detected micrometastasis in lymph nodes from superficial esophageal squamous cell carcinoma. J Surg Oncol. 2003;82:153–9.CrossRefPubMedGoogle Scholar
  11. 11.
    Arigami T, Uenosono Y, Yanagita S, et al. Clinical significance of lymph node micrometastasis in gastric cancer. Ann Surg Oncol. 2013;20:515–21.CrossRefPubMedGoogle Scholar
  12. 12.
    Sonoda H, Tani T. Clinical significance of molecular diagnosis for gastric cancer lymph node micrometastasis. World J Gastroenterol. 2014;20:13728–33.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Bilchik AJ, Hoon DS, Saha S, et al. Prognostic impact of micrometastases in colon cancer: interim results of a prospective multicenter trial. Ann Surg. 2007;246:568–77.CrossRefPubMedGoogle Scholar
  14. 14.
    Rahbari NN, Bork U, Motschall E, et al. Molecular detection of tumor cells in regional lymph nodes is associated with disease recurrence and poor survival in node-negative colorectal cancer: a systematic review and meta-analysis. J Clin Oncol. 2012;30:60–70.CrossRefPubMedGoogle Scholar
  15. 15.
    Yonemori A, Kondo S, Matsuno Y, et al. Prognostic impact of para-aortic lymph node micrometastasis in patients with regional node-positive biliary cancer. Br J Surg. 2009;96:509–16.CrossRefPubMedGoogle Scholar
  16. 16.
    Yonemori A, Kondo S, Matsuno Y, et al. Prognostic impact of regional lymph node micrometastasis in patients with node-negative biliary cancer. Ann Surg. 2010;252:99–106.CrossRefPubMedGoogle Scholar
  17. 17.
    Schwarz L, Lupinacci RM, Svrcek M, et al. Para-aortic lymph node sampling in pancreatic head adenocarcinoma. Br J Surg. 2014;101:530–8.CrossRefPubMedGoogle Scholar
  18. 18.
    Kayahara M, Funaki K, Tajima H, et al. Surgical implication of micrometastasis for pancreatic cancer. Pancreas. 2010;39:884–8.CrossRefPubMedGoogle Scholar
  19. 19.
    Kurahara H, Takao S, Maemura K, et al. Impact of lymph node micrometastasis in patients with pancreatic head cancer. World J Surg. 2007;31:483–90.CrossRefPubMedGoogle Scholar
  20. 20.
    Sobin LH, Gaspodarowicz MK, Wittekind C. International Union Against Cancer (UICC): TNM classification of malignant tumours. 7th ed. New York: Wiley-Blackwell, 2009.Google Scholar
  21. 21.
    Murakami Y, Uemura K, Sudo T, et al. Adjuvant gemcitabine plus S-1 chemotherapy after surgical resection for pancreatic adenocarcinoma. Am J Surg. 2008;195:757–62.CrossRefPubMedGoogle Scholar
  22. 22.
    Murakami Y, Uemura K, Sudo T, et al. Impact of adjuvant gemcitabine plus S-1 chemotherapy after surgical resection for adenocarcinoma of the body or tail of the pancreas. J Gastrointest Surg. 2009;13:85–92.CrossRefPubMedGoogle Scholar
  23. 23.
    Murakami Y, Uemura K, Sudo T, et al. Long-term results of adjuvant gemcitabine plus S-1 chemotherapy after surgical resection for pancreatic carcinoma. J Surg Oncol. 2012;106:174–80.CrossRefPubMedGoogle Scholar
  24. 24.
    Bandyopadhyay S, Basturk O, Coban I, et al. Isolated solitary ducts (naked ducts) in adipose tissue: a specific but underappreciated finding of pancreatic adenocarcinoma and one of the potential reasons of understaging and high recurrence rate. Am J Surg Pathol. 2009;33:425–9.CrossRefPubMedGoogle Scholar
  25. 25.
    Tol JA, Gouma DJ, Bassi C, et al. Definition of a standard lymphadenectomy in surgery for pancreatic ductal adenocarcinoma: a consensus statement by the International Study Group on Pancreatic Surgery (ISGPS). Surgery. 2014;156:591–600.CrossRefPubMedGoogle Scholar
  26. 26.
    Egawa S, Toma H, Ohigashi H, et al. Japan Pancreatic Cancer Registry; 30th year anniversary: Japan Pancreas Society. Pancreas. 2012;41:985–92.CrossRefPubMedGoogle Scholar
  27. 27.
    Ueno H, Ioka T, Ikeda M, et al. Randomized phase III study of gemcitabine plus S-1, S-1 alone, or gemcitabine alone in patients with locally advanced and metastatic pancreatic cancer in Japan and Taiwan: GEST study. J Clin Oncol. 2013;31:1640–8.CrossRefPubMedGoogle Scholar
  28. 28.
    Marthey L, Sa-Cunha A, Blanc JF, et al. FOLFIRINOX for locally advanced pancreatic adenocarcinoma: results of an AGEO multicenter prospective observational cohort. Ann Surg Oncol. 2015;22:295–301.CrossRefPubMedGoogle Scholar
  29. 29.
    Goldstein D, El-Maraghi RH, Hammel P, et al. nab-Paclitaxel plus gemcitabine for metastatic pancreatic cancer: long-term survival from a phase III trial. J Natl Cancer Inst. 2015;107:1–10.Google Scholar

Copyright information

© Society of Surgical Oncology 2016

Authors and Affiliations

  • Toshiaki Komo
    • 1
  • Yoshiaki Murakami
    • 1
  • Naru Kondo
    • 1
  • Kenichiro Uemura
    • 1
  • Yasushi Hashimoto
    • 1
  • Naoya Nakagawa
    • 1
  • Kazuhide Urabe
    • 1
  • Shinya Takahashi
    • 1
  • Taijiro Sueda
    • 1
  1. 1.Department of Surgery, Institute of Biomedical and Health SciencesHiroshima UniversityHiroshimaJapan

Personalised recommendations