title: Occult tumor cells in lymph nodes as a predictor for tumor relapse in pancreatic adenocarcinoma.
abstract: OBJECTIVE
  Occurrence of tumor relapse is frequent in patients with pancreatic cancer despite the absence of residual tumor detectable at primary surgery and in histopathological examination. Therefore, it has to be assumed that current tumor staging procedures fail to identify minimal amounts of disseminated tumor cells, which might be precursors of subsequent metastatic relapse. The aim of this study was to assess the prognostic impact of minimal tumor cell spread detected in lymph nodes classified as "tumor-free" in routine histopathologic evaluation.
  
  
  METHODS
  A total of 154 "tumor-free" lymph nodes from 59 patients with pancreatic cancer who underwent intentionally curative tumor resection were examined by immunohistochemistry for disseminated tumor cells.
  
  
  RESULTS
  Fifty (32.5%) of the "tumor-free" lymph nodes obtained from 36 (61%) patients displayed disseminated tumor cells. Multivariate survival analysis revealed that the presence of disseminated tumor cells in "tumor-free" lymph nodes is an independent prognostic factor for both a significantly reduced relapse-free survival (p = 0.03) and overall survival (p = 0.02).
  
  
  CONCLUSIONS
  The frequent occurrence and prognostic impact of immunohistochemically identifiable disseminated tumor cells in lymph nodes of patients with operable pancreatic cancer supports the need for a refined staging system of excised lymph nodes, which should include immunohistochemical examination.
authors: Department of General Surgery, Heinrich-Heine University, University Hospital Düsseldorf, Düsseldorf, Germany. scheunemann@med.uni-duesseldorf.de
authors: Peter
authors: P
authors: Scheunemann
authors: Nikolas H
authors: NH
authors: Stoecklein
authors: Alexander
authors: A
authors: Rehders
authors: Minu
authors: M
authors: Bidde
authors: Sylvia
authors: S
authors: Metz
authors: Matthias
authors: M
authors: Peiper
authors: Claus F
authors: CF
authors: Eisenberger
authors: Jan
authors: J
authors: Schulte Am Esch
authors: Wolfram T
authors: WT
authors: Knoefel
authors: Stefan B
authors: SB
authors: Hosch
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D021441:Carcinoma, Pancreatic Ductal / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D011379:Prognosis
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