IMPLICATIONS OF METASTASIS TO THE COMMON HEPATIC ARTERY NODE IN PANCREATIC ADENOCARCINOMA (PDAC): AN ANALYSIS OF A PROSPECTIVE CONTEMPORARY SERIES
Susan Kuo*1,2, Nora Horick1, Motaz Qadan1, Cristina R. Ferrone1, Keith D. Lillemoe1, Carlos Fernandez-Del Castillo1
1Massachusetts General Hospital, Boston, MA; 2Cedars-Sinai Medical Center, Los Angeles, CA
Lymph node metastasis is a well-established negative predictor of survival in PDAC, however the independent predictive value of specific lymph nodes remains equivocal. In particular, the importance of a positive common hepatic artery lymph node (CHALN+) (station 8a) has been long debated. Earlier studies showed significantly impaired survival associated with CHALN+, but others have not. We sought to contribute to this debate utilizing a more contemporary cohort where the CHALN was prospectively identified.
We analyzed a cohort of patients with head of the pancreas PDAC who underwent pancreatoduodenectomy from 2010 to 2017. A single surgeon prospectively identified the CHALN intraoperatively and submitted it separately for permanent pathological analysis. Actual 5-year overall survival (OS) was available and calculated. Overall and disease-free survival (DFS) beyond 5 years was estimated per Kaplan Meier analysis and compared via log-rank test.
217 patients had excision of the CHALN in addition to other peripancreatic lymph nodes (PPLN). 75 (35%) were PPLN-/CHALN-, 125 (58%) were PPLN+/CHALN-, and 17 (7%) were PPLN+/CHALN+. No patients had CHALN+ in absence of PPLN+. Actual 5-year OS was 50% in PPLN-/HALN-, 14% in PPLN+/HALN-, and 20% in PPLN+/HALN+. Kaplan-Meier estimates of median OS showed a significant difference between PPLN-/CHALN- and PPLN+/CHALN- (47 vs 22 months; p<0.01) and between PPLN-/CHALN- and PPLN+/CHALN+ (47 vs 25 months; p=0.02) (Figure 1). However, there was no significant difference in OS between PPLN+/CHALN- and PPLN+/CHALN+ (p=0.8). Comparative values for DFS were 38, 13, and 9 months respectively, again with no significant difference between PPLN+/CHALN- and PPLN+/CHALN+.
This contemporary PDAC cohort with prospectively collected CHALN shows that when this lymph node is positive there is no difference in survival when compared to patients who have metastatic spread to other lymph nodes. Additionally, it shows an actual 5-year survival of 50% in patients who underwent pancreatoduodenectomy for PDAC and have negative lymph nodes, and 14-20% in patients with positive lymph nodes. This improvement from previously reported rates is likely a reflection of current adjuvant and neoadjuvant therapies.
Figure 1
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