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Lymph Node Ratio and Para-Aortic Node Involvement Are Not Independent Predictors of Survival After Resection for Pancreatic Cancer Valentina Beltrame2, Mario Gruppo*1, Michele Valmasoni2, Stefano Merigliano1, Cosimo Sperti2 13rd Surgical Clinic, Padova, Italy; 2department of Surgery, Oncology and Gastroenterology, 3rd Surgical Clinic, Padua, Italy
Objectives. Lymph node involvement is an important prognostic factors for pancreatic cancer, and metastases to para-aortic nodes are considered a contraindication to radical surgery. Aim of this study was to analyze the importance of lymph node status in a series of patients who underwent pancreaticoduodenectomy in a single Institution. Methods Between January 2000 and December 2012, 144 patients underwent pancreaticoduodenectomy (PD) with para-aortic nodes dissection for pancreatic adenocarcinoma. Pathologic factors, including stage, nodal status, number of positive nodes and lymph node ratio, invasion of paraaortic nodes, tumor’s grading, and radicality of resection were studied by univariate and multivariate analysis. Survival curves were constructed with Kaplan-Meier method and compared with Log-rank test: significance was considered as p<0.05. Results A total of 107 patients (74%) had nodal metastases. Mean and median number of pathologically assessed lymph nodes were 28 and 26, respectively (range 14-63). Twenty-two patients (15%) had para-aortic lymph node involvement. Thirty-three patients (23%) underwent R1 pancreatic resection. One-hundred thirty-two patients recurred and died, two are alive with recurrence, and 10 are alive and free of disease. Overall survival was significantly influenced by grading (p=0.0001), radicality of resection (p=0.001), stage (p=0.03), lymph node status (p=0.04), para-aortic nodes metastases (p=0.02). Multivariate analysis showed that only grading was an independent prognostic factor for overall survival (p=0.0001), while grading (p=0.0001) and radicality of resection (p=0.01) were prognostic parameters for disease-free survival. Number of metastatic nodes, node ratio, and para-aortic nodes involvement were not independent predictors of disease-free and overall survival. Conclusion In this experience the number of positive lymph nodes did not have prognostic implication in patients with node positive pancreatic cancer. Although lymph node status and para-aortic node metastases were associated with poor survival at univariate analysis, they were not independent prognostic index. So, the decision to perform pancreatic resection should not be taken on the basis of lymph node status only. Back to 2016 Annual Meeting |
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