title: Number of involved lymph nodes is important in the prediction of prognosis for primary duodenal adenocarcinoma.
abstract: BACKGROUND
  The significance of lymph node involvement regarding the prognosis of primary duodenal adenocarcinoma remains controversial. This study aims to evaluate the prognostic accuracy of nodal metastasis using the seventh edition American Joint Committee on Cancer staging system in patients with primary duodenal adenocarcinoma.
  
  
  METHODS
  Between 1993 and 2010, 36 patients who had undergone surgical resection for primary duodenal adenocarcinoma at the Kaohsiung Veterans General Hospital were retrospectively reviewed.
  
  
  RESULTS
  The median disease-free survival for all patients was 19 months and the median overall survival was 21 months. Lymph node metastases were found in 26 (72%) of the patients, and 14 patients (39%) patients had in excess of three positive lymph nodes (N2). Patients with N2 disease had significantly reduced overall survival, as compared to patients with three or fewer positive lymph nodes (N1; p = 0.036). In univariate analysis, factors including age >75 years, body weight loss, tumor size ≤ 4 cm, N2 disease and lymph node ratio >0.4 predicted shorter overall survival. Multivariate analysis demonstrated that N2 and lymph node ratio >0.4 are significant risk factors associated with overall survival (p = 0.026 and p = 0.042 respectively). N2 is also the only independent predictive factor for disease-free survival (p = 0.023).
  
  
  CONCLUSIONS
  Subdivision of metastatic lymph nodes into N1 and N2 improves predictive ability. The seventh edition American Joint Committee on Cancer staging system is applicable in the present study with regard to the prediction of the prognosis for primary duodenal adenocarcinoma.
authors.affiliation: Department of Surgery, Kaohsiung Veterans General Hospital, Pingtung Branch, Pingtung, Taiwan, ROC.
authors.forename: Tsung-Jung
authors.initials: TJ
authors.lastname: Liang
authors.forename: Being-Whey
authors.initials: BW
authors.lastname: Wang
authors.forename: Shiuh-Inn
authors.initials: SI
authors.lastname: Liu
authors.forename: Nan-Hua
authors.initials: NH
authors.lastname: Chou
authors.forename: Cheng-Chung
authors.initials: CC
authors.lastname: Tsai
authors.forename: I-Shu
authors.initials: IS
authors.lastname: Chen
authors.forename: Ming-Hsin
authors.initials: MH
authors.lastname: Yeh
authors.forename: Yu-Chia
authors.initials: YC
authors.lastname: Chen
authors.forename: Po-Min
authors.initials: PM
authors.lastname: Chang
authors.forename: King-Tong
authors.initials: KT
authors.lastname: Mok
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004379:Duodenal Neoplasms / Q000401:mortality*; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D011379:Prognosis