Epidemiology

Lymph node metastases in resected pancreatic ductal adenocarcinoma: predictors of disease recurrence and survival

  • British Journal of Cancer volume 117, pages 18741882 (05 December 2017)
  • doi:10.1038/bjc.2017.349
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Abstract

Background:

Few studies have simultaneously assessed the prognostic value of the multiple classification systems for lymph node (LN) metastases in resected pancreatic ductal adenocarcinoma (PDAC).

Methods:

In 600 patients with resected PDAC, we examined the association of LN parameters (AJCC 7th and 8th editions, LN ratio (LNR), and log odds of metastatic LN (LODDS)) with pattern of recurrence and patient survival using logistic regression and Cox proportional hazards regression, respectively. Regression models adjusted for age, sex, margin status, tumour grade, and perioperative therapy.

Results:

Lymph node metastases classified by AJCC 7th and 8th editions, LNR, and LODDS were associated with worse disease free-survival (DFS) and overall survival (OS) (all Ptrend<0.01). American Joint Committee on Cancer 8th edition effectively predicted DFS and OS, while minimising model complexity. Lymph node metastases had weaker prognostic value in patients with positive margins and distal resections (both Pinteraction<0.03). Lymph node metastases by AJCC 7th and 8th editions did not predict the likelihood of local disease as the first site of recurrence.

Conclusions:

American Joint Committee on Cancer 8th edition LN classification is an effective and practical tool to predict outcomes in patients with resected PDAC. However, the prognostic value of LN metastases is attenuated in patients with positive resection margins and distal pancreatectomies.

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Change history

  • Corrected online 05 December 2017

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Acknowledgements

This work was supported by NIH K07 CA148894 (to KN); by NCI R35 CA197735 (to SO); by the Robert T and Judith B Hale Fund for Pancreatic Cancer, Perry S Levy Fund for Gastrointestinal Cancer Research, Pappas Family Research Fund for Pancreatic Cancer, NIH R01 CA124908, and NIH P50 CA127003 (to CSF); MyBlueDots Fund (to ACK); and by NIH/NCI U01 CA210171, Department of Defense CA130288, Lustgarten Foundation, Pancreatic Cancer Action Network, Noble Effort Fund, Peter R Leavitt Family Fund, Wexler Family Fund, and Promises for Purple (to BMW).

Author information

Author notes

    • Vicente Morales-Oyarvide
    •  & Douglas A Rubinson

    Co-first authors.

Affiliations

  1. Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, 450 Brookline Avenue, Boston, MA 02215, USA

    • Vicente Morales-Oyarvide
    • , Douglas A Rubinson
    • , Chen Yuan
    • , Zhi Rong Qian
    • , Ana Babic
    • , Annacarolina Da Silva
    • , Lauren K Brais
    • , Marisa W Welch
    • , Caitlin L Zellers
    • , Kimmie Ng
    • , Shuji Ogino
    • , Charles S Fuchs
    •  & Brian M Wolpin
  2. Department of Medicine, Division of Hematology and Oncology, Wilmot Cancer Institute, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY 14642, USA

    • Richard F Dunne
    •  & Aram F Hezel
  3. Department of Radiation Oncology, Stanford Cancer Institute, 269 Campus Drive West, Stanford, CA 94305-5152, USA

    • Margaret M Kozak
    • , Justin L Bui
    •  & Daniel T Chang
  4. Department of Epidemiology, Harvard TH Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA

    • Chen Yuan
    •  & Shuji Ogino
  5. Department of Pathology, Brigham and Women’s Hospital and Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA

    • Jonathan A Nowak
    • , Leona A Doyle
    • , Jason L Hornick
    •  & Shuji Ogino
  6. Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115, USA

    • Natalia Khalaf
  7. Department of Hematology and Oncology, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA

    • Rebecca A Miksad
    •  & Andrea J Bullock
  8. Department of Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA

    • Jennifer F Tseng
  9. Department of Surgery, Brigham and Women’s Hospital and Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA

    • Richard S Swanson
    •  & Thomas E Clancy
  10. Department of Surgery, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY 14642, USA

    • David C Linehan
  11. Department of Pathology, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY 14642, USA

    • Jennifer J Findeis-Hosey
  12. Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1840 Old Spanish Trail, Houston, TX 77054, USA

    • Albert C Koong

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Competing interests

The authors declare no conflict of interest.

Corresponding author

Correspondence to Brian M Wolpin.

Supplementary information

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Supplementary Information accompanies this paper on British Journal of Cancer website (http://www.nature.com/bjc)

Creative Commons BY-NC-SAFrom twelve months after its original publication, this work is licensed under the Creative Commons Attribution-NonCommercial-Share Alike 4.0 Unported License. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc-sa/4.0/