title: Prognostic assessment of different lymph node staging methods for pancreatic cancer with R0 resection: pN staging, lymph node ratio, log odds of positive lymph nodes.
abstract: OBJECTIVE
  Survival after surgical resection of pancreatic adenocarcinoma is poor. Several prognostic factors such as the status of the resection margin, lymph node status, or tumour grading have been identified. The aims of the present study were to evaluate and compare the prognostic assessment of different lymph nodes staging methods: standard lymph node (pN) staging, metastatic lymph node ratio (LNR), and log odds of positive lymph nodes (LODDS) in pancreatic cancer after pancreatic resection.
  
  
  METHODS
  Data were retrospectively collected from 143 patients who had undergone R0 pancreatic resection for pancreatic ductal adenocarcinoma. Survival curves (Kaplan-Meier and Cox proportional hazard models), accuracy, and homogeneity of the 3 methods (LNR, LODDS, and pN) were compared to evaluate the prognostic effects.
  
  
  RESULTS
  Multivariate analysis demonstrated that LODDS and LNR were an independent prognostic factors, but not pN classification. The scatter plots of the relationship between LODDS and the LNR suggested that the LODDS stage had power to divide patients with the same ratio of node metastasis into different groups. For patients in each of the pN or LNR classifications, significant differences in survival could be observed among patients in different LODDS stages.
  
  
  CONCLUSIONS
  LODDS and LNR are more powerful predictors of survival than the lymph node status in patients undergoing pancreatic resection for ductal adenocarcinoma. LODDS allows better prognostic stratification comparing LNR in node negative patients.
authors: Department of General Surgery, Surgical Department of Clinical Sciences, Biomedical Technologies and Translational Medicine, Faculty of Medicine and Psychology, University of Rome "La Sapienza", St. Andrea Hospital, Via di Grottarossa, 1035-39, 00189 Rome, Italy. Electronic address: marco.latorre@uniroma1.it.
authors: Marco
authors: M
authors: La Torre
authors: Department of Hepato-Biliary and Pancreatic Surgery, Surgical Department of Clinical Sciences, Biomedical Technologies and Translational Medicine, Faculty of Medicine and Psychology, University of Rome "La Sapienza", St. Andrea Hospital, Via di Grottarossa, 1035-39, 00189 Rome, Italy.
authors: Giuseppe
authors: G
authors: Nigri
authors: Department of General Surgery, Surgical Department of Clinical Sciences, Biomedical Technologies and Translational Medicine, Faculty of Medicine and Psychology, University of Rome "La Sapienza", St. Andrea Hospital, Via di Grottarossa, 1035-39, 00189 Rome, Italy.
authors: Niccolò
authors: N
authors: Petrucciani
authors: Department of General Surgery, Surgical Department of Clinical Sciences, Biomedical Technologies and Translational Medicine, Faculty of Medicine and Psychology, University of Rome "La Sapienza", St. Andrea Hospital, Via di Grottarossa, 1035-39, 00189 Rome, Italy.
authors: Marco
authors: M
authors: Cavallini
authors: Department of Hepato-Biliary and Pancreatic Surgery, Surgical Department of Clinical Sciences, Biomedical Technologies and Translational Medicine, Faculty of Medicine and Psychology, University of Rome "La Sapienza", St. Andrea Hospital, Via di Grottarossa, 1035-39, 00189 Rome, Italy.
authors: Paolo
authors: P
authors: Aurello
authors: Department of General Surgery, Surgical Department of Clinical Sciences, Biomedical Technologies and Translational Medicine, Faculty of Medicine and Psychology, University of Rome "La Sapienza", St. Andrea Hospital, Via di Grottarossa, 1035-39, 00189 Rome, Italy.
authors: Giulia
authors: G
authors: Cosenza
authors: Department of General Surgery, Surgical Department of Clinical Sciences, Biomedical Technologies and Translational Medicine, Faculty of Medicine and Psychology, University of Rome "La Sapienza", St. Andrea Hospital, Via di Grottarossa, 1035-39, 00189 Rome, Italy.
authors: Genoveffa
authors: G
authors: Balducci
authors: Department of General Surgery, Surgical Department of Clinical Sciences, Biomedical Technologies and Translational Medicine, Faculty of Medicine and Psychology, University of Rome "La Sapienza", St. Andrea Hospital, Via di Grottarossa, 1035-39, 00189 Rome, Italy.
authors: Vincenzo
authors: V
authors: Ziparo
authors: Department of Hepato-Biliary and Pancreatic Surgery, Surgical Department of Clinical Sciences, Biomedical Technologies and Translational Medicine, Faculty of Medicine and Psychology, University of Rome "La Sapienza", St. Andrea Hospital, Via di Grottarossa, 1035-39, 00189 Rome, Italy.
authors: Giovanni
authors: G
authors: Ramacciato
mesh_terms: D000368:Aged; D021441:Carcinoma, Pancreatic Ductal / Q000175:diagnosis* / Q000000981:diagnostic imaging; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010190:Pancreatic Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging; D016577:Pancreaticoduodenectomy; D011379:Prognosis; D016019:Survival Analysis; D014463:Ultrasonography
keywords: LODDS; Log odds of positive lymph nodes; Lymph node metastasis; Lymph node ratio; Pancreatic cancer surgery; pN staging