Abstract | BACKGROUND: METHODS: The National Cancer Data Base was queried for patients with nonmetastatic pancreatic adenocarcinoma (2004-2013) who underwent classic pancreaticoduodenectomy with antrectomy. Logistic regression was performed for odds of node positivity. Kaplan-Meier curves and Cox proportional hazards models were used to assess the impact of lymph node status on overall survival for patients diagnosed during 2-year intervals from 2004-2012. RESULTS: Median number of examined lymph nodes was 10 (interquartile range 6-15) in 2004 vs 17 (interquartile range 12-24) in 2013. Number of lymph nodes examined was a significant predictor of N1 disease (P < .0001), with a plateau at 30 nodes. N1 disease increased from 64.4% to 68.0% (P < .0001). Survival for both N1 and N0 subgroups improved. In successive multivariate models, N0 versus N1 status was consistently protective for overall survival (P < .0001), but there was no change in the magnitude of its hazard ratio over time (overall hazard ratio 0.691; 95% confidence interval 0.660-0.723). CONCLUSION: Contemporary patients have an adequate number of nodes examined during standard pancreaticoduodenectomy. This, along with rising rates of N1 cancer detection and improved survival for both node-positive and node-negative patients, suggest more accurate classification of lymph node status. However, no increased benefit is achieved beyond 30 nodes. Overall, lymph node status remains a strong prognosticator for overall survival.
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Authors | Mariam F Eskander, Susanna W L de Geus, Gyulnara G Kasumova, Sing Chau Ng, Waddah Al-Refaie, Gamze Ayata, Jennifer F Tseng |
Journal | Surgery
(Surgery)
Vol. 161
Issue 4
Pg. 968-976
(04 2017)
ISSN: 1532-7361 [Electronic] United States |
PMID | 27865602
(Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
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Copyright | Copyright © 2016 Elsevier Inc. All rights reserved. |
Topics |
- Adult
- Aged
- Cohort Studies
- Databases, Factual
- Disease-Free Survival
- Female
- Humans
- Kaplan-Meier Estimate
- Logistic Models
- Lymph Node Excision
(methods, statistics & numerical data)
- Lymph Nodes
(pathology, surgery)
- Male
- Middle Aged
- Neoplasm Invasiveness
(pathology)
- Neoplasm Staging
- Odds Ratio
- Pancreatic Neoplasms
(mortality, pathology, surgery)
- Pancreaticoduodenectomy
(methods, mortality)
- Prognosis
- Proportional Hazards Models
- Retrospective Studies
- Risk Assessment
- Survival Analysis
- Treatment Outcome
- Young Adult
- Pancreatic Neoplasms
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