title: Pancreatic cancer patients with lymph node involvement by direct tumor extension have similar survival to those with node-negative disease.
abstract: BACKGROUND
  Lymph node (LN) involvement is a well-known poor prognostic factor in patients with pancreatic ductal adenocarcinoma (PDAC). However, there have been conflicting results on the significance of the mechanism of LN involvement, "direct" tumor invasion versus "metastatic," disease on patient survival.
  
  
  METHODS
  Clinicopathologic records from all patients who underwent resection for PDAC from 1990 to 2014 at a single-institution were reviewed.
  
  
  RESULTS
  Of the 385 total patients, there was tumor invasion outside of the pancreas in 289 (75.1%) patients. Overall, 239 (62.1%) had node-positive disease: 220 (92.0%) by "metastatic" involvement, 14 (5.9%) by "direct" tumor extension, and five (2.1%) by a mix of "metastatic" and "direct". There were no significant differences in clinicopathologic factors associated with PDAC survival between "metastatic" and "direct" LN patients. The median overall survival for the whole cohort was 31.1 months. Compared to overall survival in patients with LN-negative disease (median 40.7 months), those with LNs involved by "metastatic" spread was significantly shorter (median 25.7 months, P < 0.001), yet "direct" LN extension was similar (median 48.1 months, P = 0.719).
  
  
  CONCLUSIONS
  The mechanism of LN involvement affects PDAC prognosis. Patients with LNs involved by direct extension have similar survival to those with node-negative disease.
authors: Department of Surgery, Harbor-UCLA Medical Center, Torrance, California.
authors: Jennifer L
authors: JL
authors: Williams
authors: Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California.
authors: Andrew H
authors: AH
authors: Nguyen
authors: Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California.
authors: Matthew
authors: M
authors: Rochefort
authors: Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California.
authors: V Raman
authors: VR
authors: Muthusamy
authors: Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California.
authors: Zev A
authors: ZA
authors: Wainberg
authors: Department of Pathology, David Geffen School of Medicine at UCLA, Los Angeles, California.
authors: David W
authors: DW
authors: Dawson
authors: Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California.
authors: James S
authors: JS
authors: Tomlinson
authors: Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California.
authors: O Joe
authors: OJ
authors: Hines
authors: Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California.
authors: Howard A
authors: HA
authors: Reber
authors: Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California.|Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, Los Angeles, California.
authors: Timothy R
authors: TR
authors: Donahue
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality* / Q000556:secondary / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D021441:Carcinoma, Pancreatic Ductal / Q000401:mortality* / Q000556:secondary / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology* / Q000601:surgery; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D010180:Pancreatectomy / Q000401:mortality*; D010190:Pancreatic Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D011379:Prognosis; D011446:Prospective Studies; D015996:Survival Rate; D055815:Young Adult
keywords: TNM staging; neoplasm metastasis; pancreatic cancer