title: Hepatic arterial nodal metastases in pancreatic cancer: is this the node of importance?
abstract: BACKGROUND
  The hepatic artery lymph node (HALN) is frequently sampled during pancreaticoduodenectomy (PD). Data suggest that survival in the setting of HALN metastases is similar to that of stage IV pancreatic ductal adenocarcinoma (PDAC). The objectives of this study were to describe the prognostic significance of HALN metastases and to assess the predictive performance of HALN compared to peripancreatic lymph node status.
  
  
  METHODS
  Patients undergoing PD for PDAC from January 2000-October 2010 were identified from a prospectively maintained database. Patients were included if during PD the HALN was submitted for pathologic evaluation. Patients were excluded if margins were macroscopically positive, if pathology was found to be consistent with a diagnosis other than PDAC. Overall (OS) and disease-free survival (DFS) were estimated by Kaplan-Meier methods.
  
  
  RESULTS
  Of the 671 patients who underwent PD for PDAC, HALN status was analyzed for 147 patients. HALN was positive in 23 patients (16 %), 38 were peripancreatic lymph node (PPLN) and HALN negative, and 86 were PPLN+/HALN-. Median follow-up for survivors was 10 months. In a multivariable model, lymph node status and tumor differentiation predicted OS and DFS. Hazard of death and relapse/death were highest among the HALN+ patients (hazard ratio [HR] 2.94; p = 0.017 and HR 2.66; p = 0.011, respectively). Kaplan-Meier analysis revealed significant differences in OS (p = 0.017) and DFS (p = 0.013) based on lymph node status.
  
  
  CONCLUSIONS
  OS and DFS are significantly reduced in patients with a positive HALN. Differentiation and lymph node status were predictors of OS and DFS. In the multivariate models, differentiation and lymph node status remain independent predictors of OS and DFS.
authors.affiliation: Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA.
authors.forename: J
authors.initials: J
authors.lastname: LaFemina
authors.forename: J F
authors.initials: JF
authors.lastname: Chou
authors.forename: M
authors.initials: M
authors.lastname: Gönen
authors.forename: F G
authors.initials: FG
authors.lastname: Rocha
authors.forename: C
authors.initials: C
authors.lastname: Correa-Gallego
authors.forename: T P
authors.initials: TP
authors.lastname: Kingham
authors.forename: Y
authors.initials: Y
authors.lastname: Fong
authors.forename: M I
authors.initials: MI
authors.lastname: D'Angelica
authors.forename: W R
authors.initials: WR
authors.lastname: Jarnagin
authors.forename: R P
authors.initials: RP
authors.lastname: DeMatteo
authors.forename: P J
authors.initials: PJ
authors.lastname: Allen
mesh_terms: D000368:Aged; D021441:Carcinoma, Pancreatic Ductal / Q000556:secondary* / Q000601:surgery; D018572:Disease-Free Survival; D005260:Female; D006499:Hepatic Artery; D006801:Humans; D053208:Kaplan-Meier Estimate; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D010179:Pancreas; D010190:Pancreatic Neoplasms / Q000473:pathology* / Q000601:surgery; D016577:Pancreaticoduodenectomy; D011237:Predictive Value of Tests; D012189:Retrospective Studies