Daisuke Asano1,2, Satoshi Nara3, Yoji Kishi1, Minoru Esaki1, Nobuyoshi Hiraoka4, Minoru Tanabe2, Kazuaki Shimada1. 1. Hepatobiliary and Pancreatic Surgery Division, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan. 2. Department of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan. 3. Hepatobiliary and Pancreatic Surgery Division, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan. sanara@ncc.go.jp. 4. Division of Pathology and Clinical Laboratories, National Cancer Center Hospital, Tokyo, Japan.
Abstract
BACKGROUND: According to the revised staging of the American Joint Committee on Cancer, 8th edition (AJCC8), the N category in pancreatic ductal adenocarcinoma is classified as N0 (0), N1 (1-3), and N2 (≥ 4) based on the number of metastatic lymph nodes (LNs). This study aimed to validate this classification and analyze cutoff values of metastatic LN numbers. METHODS: Patients with pancreatic head ductal adenocarcinoma who underwent pancreaticoduodenectomy at our institution between 2005 and 2016 without preoperative therapy were retrospectively analyzed. The patients were staged by AJCC8, and prognostic analyses were performed. The best cutoff value for the metastatic LN number was determined by the minimum P value approach. RESULTS: In 228 of 309 patients, LN metastases were found (median number of examined LNs, 41). The median survival time (MST) was 56 months in the N0 group, 34 months in the N1 group, and 20 months in the N2 group (N0 vs N1: P = 0.023; N1 vs N2: P < 0.001). The best cutoff number of metastatic LNs was 4 for patients with LN metastases and 7 for patients with N2 disease. The MST for patients with four to six positive nodes (N2a) was significantly longer than for those with seven or more positive nodes (N2b) (24.0 vs 19.1 months: P = 0.012). For N2b patients, conventional adjuvant chemotherapy did not show survival benefits (P = 0.133), and overall survival did not differ significantly from that for patients with para-aortic LN metastasis (P = 0.562). CONCLUSION: The N staging of AJCC8 was valid. Clinicians should regard N2b as similar to distant LN metastasis, and more intensive adjuvant therapy may be indicated for this group.
BACKGROUND: According to the revised staging of the American Joint Committee on Cancer, 8th edition (AJCC8), the N category in pancreatic ductal adenocarcinoma is classified as N0 (0), N1 (1-3), and N2 (≥ 4) based on the number of metastatic lymph nodes (LNs). This study aimed to validate this classification and analyze cutoff values of metastatic LN numbers. METHODS:Patients with pancreatic head ductal adenocarcinoma who underwent pancreaticoduodenectomy at our institution between 2005 and 2016 without preoperative therapy were retrospectively analyzed. The patients were staged by AJCC8, and prognostic analyses were performed. The best cutoff value for the metastatic LN number was determined by the minimum P value approach. RESULTS: In 228 of 309 patients, LN metastases were found (median number of examined LNs, 41). The median survival time (MST) was 56 months in the N0 group, 34 months in the N1 group, and 20 months in the N2 group (N0 vs N1: P = 0.023; N1 vs N2: P < 0.001). The best cutoff number of metastatic LNs was 4 for patients with LN metastases and 7 for patients with N2 disease. The MST for patients with four to six positive nodes (N2a) was significantly longer than for those with seven or more positive nodes (N2b) (24.0 vs 19.1 months: P = 0.012). For N2b patients, conventional adjuvant chemotherapy did not show survival benefits (P = 0.133), and overall survival did not differ significantly from that for patients with para-aortic LN metastasis (P = 0.562). CONCLUSION: The N staging of AJCC8 was valid. Clinicians should regard N2b as similar to distant LN metastasis, and more intensive adjuvant therapy may be indicated for this group.
Authors: Feng Yin; Mohammed Saad; Hao Xie; Jingmei Lin; Christopher R Jackson; Bing Ren; Cynthia Lawson; Dipti M Karamchandani; Belen Quereda Bernabeu; Wei Jiang; Teena Dhir; Richard Zheng; Christopher W Schultz; Dongwei Zhang; Courtney L Thomas; Xuchen Zhang; Jinping Lai; Michael Schild; Xuefeng Zhang; Xiuli Liu Journal: World J Gastrointest Pharmacol Ther Date: 2020-06-09
Authors: Thijs J Schouten; Lois A Daamen; Galina Dorland; Stijn R van Roessel; Vincent P Groot; Marc G Besselink; Bert A Bonsing; Koop Bosscha; Lodewijk A A Brosens; Olivier R Busch; Ronald M van Dam; Arantza Fariña Sarasqueta; Sebastiaan Festen; Bas Groot Koerkamp; Erwin van der Harst; Ignace H J T de Hingh; Martijn Intven; Geert Kazemier; Vincent E de Meijer; Vincent B Nieuwenhuijs; G Mihaela Raicu; Daphne Roos; Jennifer M J Schreinemakers; Martijn W J Stommel; M F van Velthuysen; Robert C Verdonk; Joanne Verheij; Helena M Verkooijen; Hjalmar C van Santvoort; I Quintus Molenaar Journal: Ann Surg Oncol Date: 2022-04-25 Impact factor: 4.339