Does the Mechanism of Lymph Node Invasion Affect Survival in Patients with Pancreatic Ductal Adenocarcinoma?

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Does the Mechanism of Lymph Node Invasion Affect Survival in Patients with Pancreatic Ductal Adenocarcinoma?

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Title: Does the Mechanism of Lymph Node Invasion Affect Survival in Patients with Pancreatic Ductal Adenocarcinoma?
Author: Konstantinidis, Ioannis T; Deshpande, Vikram; Hui, Hui; Wargo, Jennifer Ann; Fernandez-Del Castillo, Carlos F.; Thayer, Sarah P.; Androutsopoulos, Vasiliki; Lauwers, Gregory Y.; Warshaw, Andrew Louis; Ferrone, Cristina Rosa

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Citation: Konstantinidis, Ioannis T., Vikram Deshpande, Hui Zheng, Jennifer A. Wargo, Carlos Fernandez-del Castillo, Sarah P. Thayer, Vasiliki Androutsopoulos, Gregory Y. Lauwers, Andrew L. Warshaw, and Cristina R. Ferrone. 2010. Does the mechanism of lymph node invasion affect survival in patients with pancreatic ductal adenocarcinoma? Journal of Gastrointestinal Surgery 14(2): 261–267.
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Abstract: Background: Lymph node metastases are prognostically significant in pancreatic ductal adenocarcinoma. Little is known about the significance of direct lymph node invasion. Aim: The aim of this study is to find out whether direct lymph node invasion has the same prognostic significance as regional nodal metastases. Methods: Retrospective review of patients resected between 1/1/1993 and 7/31/2008. “Direct” was defined as tumor extension into adjacent nodes, and “regional” was defined as metastases to peripancreatic nodes. Results: Overall, 517 patients underwent pancreatic resection for adenocarcinoma, of whom 89 had one positive node (direct 26, regional 63), and 79 had two positive nodes (direct 6, regional 68, both 5). Overall, survival of node-negative patients was improved compared to patients with positive nodes (N0 30.8 months vs. N1 16.4 months; p < 0.001). There was no survival difference for patients with direct vs. regional lymph node invasion (p = 0.67). Patients with one positive node had a better overall survival compared to patients with ≥2 positive nodes (22.3 and 15 months, respectively; p < 0.001). The lymph node ratio (+LN/total LN) was prognostically significant after Cox regression (p < 0.001). Conclusions: Isolated direct invasion occurs in 20% of patients with one to two positive nodes. Node involvement by metastasis or by direct invasion are equally significant predictors of reduced survival. Both the number of positive nodes and the lymph node ratio are significant prognostic factors.
Published Version: doi:10.1007/s11605-009-1096-z
Other Sources: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3135335/
Terms of Use: This article is made available under the terms and conditions applicable to Other Posted Material, as set forth at http://nrs.harvard.edu/urn-3:HUL.InstRepos:dash.current.terms-of-use#LAA
Citable link to this page: http://nrs.harvard.edu/urn-3:HUL.InstRepos:32539258
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