SSAT - Prognostic IMpact of PAra-Aortic LYmph NOde MIcrometastasis in PAncreatic DUctal aDenocarcinoma

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Prognostic IMpact of PAra-Aortic LYmph NOde MIcrometastasis in PAncreatic DUctal aDenocarcinoma
Toshiaki Komo^*, Yoshiaki Murakami, Kenichiro Uemura, Yasushi Hashimoto, Naru Kondo, Naoya Nakagawa, Hayato Sasaki, Taijiro Sueda

Department of Surgery, Applied Life Sciences institute of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan

Background: It is still unclear whether micrometastasis of para-aorta lymph node (PALN) in pancreatic ductal adenocarcinoma (PDAC) is tantamount to PALN metastasis detected by hematoxylin and eosin (HE) staining. The aim of this study is to clarify the prognostic impact of PALN micrometastasis in resected PDAC.
Methods: Of 223 patients with surgical resection for PDAC, 195 (87%) with pathological assessment for dissected PALNs were eligible for this study. Micrometastasis in PALN was investigated by immunohistochemistry with Anti-Cytokeratin (CAM 5.2) in the sections of PALN that were diagnosed as absent of metastasis by HE staining. Relationship of clinicopathological factors including PALN metastasis with overall survival (OS) were analyzed by univariate and multivariate analyses.
Results: Of the 195 enrolled patients, 19 (10%) had PALN HE-positive, and 17 (9%) had PALN HE-negative but PALN micrometastasis positive. Univariate analysis revealed that patients with PALN micrometastasis positive (p = 0.002) and HE-positive (p = 0.003) had a significantly shorter OS than those without PALN metastasis. In addition, survival of patients with PALN micrometastasis positive was similar with that of PALN HE-positive (p=0.719). In multivariate analysis, absent of postoperative adjuvant chemotherapy (HR: 2.39, p<0.001), PALN micrometastasis positive (HR: 2.92, p=0.003), and PALN HE-positive (HR: 1.82, p=0.036) were identified as independent risk factors for poor prognosis. Within a subset of 36 patients with PALN HE-positive or micrometastasis positive, patients with adjuvant chemotherapy had significantly longer OS than those without. (p < 0.001)
Conclusions: The prognosis of patients with micrometastasis of PALN is extremely poor as well as that of patients with PALN HE-positive. However, postoperative adjuvant chemotherapy may contribute to improve the prognosis of PDAC patients with PALN metastasis.

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