Strong prognostic value of nodal and bone marrow micro-involvement in patients with pancreatic ductal carcinoma receiving no adjuvant chemotherapy.
OBJECTIVE
To study the prognostic value of adjuvant chemotherapy in patients with pancreatic, ductal adenocarcinoma.


METHODS
Lymph nodes from 106 patients with resectable pancreatic ductal adenocarcinoma were systematically sampled. A total of 318 lymph nodes classified histopathologically as tumor-free were examined using sensitive immunohistochemical assays. Forty-three (41%) of the 106 patients were staged as pT((1/2)), 63 (59%) as pT((3/4)), 51 (48%) as pN(0), and 55 (52%) as pN(1). The study population included 59 (56%) patients exhibiting G((1/2)), and 47 (44%) patients with G(3) tumors. Patients received no adjuvant chemo- or radiation therapy and were followed up for a median of 12 (range: 3.5 to 139) mo.


RESULTS
Immunostaining with Ber-EP4 revealed nodal microinvolvement in lymph nodes classified as "tumor free" by conventional histopathology in 73 (69%) out of the 106 patients. Twenty-nine (57%) of 51 patients staged histopathologically as pN(0) had nodal microinvolvement. The five-year survival probability for pN0-patients was 54% for those without nodal microinvolvement and 0% for those with nodal microinvolvement. Cox-regression modeling revealed the independent prognostic effect of nodal microinvolvement on recurrence-free (relative risk 2.92, P=0.005) and overall (relative risk 2.49, P=0.009) survival.


CONCLUSIONS
The study reveals strong and independent prognostic significance of nodal microinvolvement in patients with pancreatic ductal adenocarcinoma who have received no adjuvant therapy. The addition of immunohistochemical findings to histopathology reports may help to improve risk stratification of patients with pancreatic cancer.
Yekebas
Emre-F
EF
Department of General, Visceral and Thoracic Surgery, University Medical Centre of Hamburg-Eppendorf, MartinistraBe 52, 20246 Hamburg, Germany.
Bogoevski
Dean
D
Bubenheim
Michael
M
Link
Björn-Christian
BC
Kaifi
Jussuf-T
JT
Wachowiak
Robin
R
Mann
Oliver
O
Kutup
Asad
A
Cataldegirmen
Guellue
G
Wolfram
Lars
L
Erbersdobler
Andreas
A
Klein
Christoph
C
Pantel
Klaus
K
Izbicki
Jakob-R
JR
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001853:Bone Marrow / Q000473:pathology*; D021441:Carcinoma, Pancreatic Ductal / Q000188:drug therapy / Q000473:pathology*; D017024:Chemotherapy, Adjuvant; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis / Q000175:diagnosis / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D010190:Pancreatic Neoplasms / Q000188:drug therapy / Q000473:pathology*; D011237:Predictive Value of Tests; D011379:Prognosis; D015996:Survival Rate