LYMPH NODE DISSECTION DOES NOT IMPROVE SURVIVAL IN PATIENTS WITH PANCREATIC NEUROENDOCRINE TUMOR: A STUDY OF THE NATIONAL CANCER DATABASE
Rui Mao*1,2, Sheng Luo3, Megan Turner4, Jian-Qiang Cai1, Hong Zhao1, Dan G. Blazer4
1Department of Hepatobiliary Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Durham, NC; 2Duke Clinical Research Institute, Duke University Medical Center, Durham, NC; 3Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC; 4Department of Surgery, Duke University Medical Center, Durham, NC
Background
Although the National Comprehensive Cancer Network (NCCN) guideline recommends use of lymph node dissection (LND) in patients with pancreatic neuroendocrine tumors (pNETs) > 2 cm, there is limited evidence to support the association between use of LND and overall survival (OS).
Methods
Patients with resected non-metastatic pNETs were identified in the National Cancer Database (2004-2014). Propensity score matching method was used to reduce the selection bias. Kaplan-Meier curves and Cox proportional hazards regression analyses were used to compare OS of patients in different treatment groups. In addition, we performed subgroup analyses of treatment effect according to pathological T stage and tumor grade.
Results
A total of 4007 patients diagnosed between 2004 and 2014 met the study entry criteria. Of these, 3258 patients (81.3%) received LND, with median 10 nodes removed. After matching, 722 patients with LND were compared with 722 patients who did not receive LND. Over a median follow-up of 43.6 months, patients treated with LND demonstrated similar OS to those who did not receive LND (hazard ratio, 0.91, 95% CI, 0.60-1.39, p = 0.66). Among patients with a metastatic lymph node, 322 patients with the number of removed nodes (NRN) above the median were matched to 322 patients with NRN below the median. NRN above the median was not associated with an improved OS (HR = 1.22, 95% CI, 0.85-1.75, p = 0.29). The results were consistent across subgroups (all Bonferroni p > 0.008).
Conclusions
LND has no therapeutic effect among patients with pNETs. The present findings should be considered when considering surgical options for patients with resectable pNETs.
Figure 1. Kaplan-Meier curves for overall survival of matched patients in the LND and LND-omitted group.
Figure 2. Kaplan-Meier curves for overall survival of matched patients with LNM in the NRN < 10 and NRN ≥ 10 group.
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