title: Extranodal extension in N1-adenocarcinoma of the pancreas and papilla of Vater: a systematic review and meta-analysis of its prognostic significance.
abstract: The aim of the study was to investigate the prognostic role of extranodal extension (ENE) of lymph node metastasis in adenocarcinoma of the pancreas (PDAC) and papilla [cancer of the papilla of Vater (CPV)]. A PubMed and SCOPUS search from database inception until 5 January 2015 without language restrictions was conducted. Eligible were prospective studies reporting data on prognostic parameters in individuals with PDAC and/or CPV, comparing participants with the presence of ENE (ENE+) with those with intranodal extension (ENE-). Data were summarized using risk ratios for number of deaths/recurrences and hazard ratios for time-dependent risk related to ENE+, adjusted for potential confounders. ENE was found to be very common in these tumors (up to about 60% in both N1-PDAC and CPV), leading to a significant increased risk for all-cause mortality [risk ratio=1.20; 95% confidence interval (CI): 1.06-1.35, P=0.003, I(2)=44%; hazard ratio=1.415, 95% CI: 1.215-1.650, P<0.0001, I(2)=0%] and recurrence of disease (risk ratio=1.20, 95% CI: 1.03-1.40, P=0.02, I(2)=0%). On the basis of our results, in PDAC and CPV, ENE should be considered mandatorily from the gross sampling and pathology report to the oncologic staging and therapeutic approach.
authors.affiliation: aDepartment of Pathology and Diagnostics, University and Hospital Trust of Verona, Verona Departments of bMedicine (DIMED) cNeurosciences, University of Padua, Padua, Italy dDepartment of Surgery, Johns Hopkins University, Baltimore, Maryland, USA.
authors.forename: Claudio
authors.initials: C
authors.lastname: Luchini
authors.forename: Nicola
authors.initials: N
authors.lastname: Veronese
authors.forename: Antonio
authors.initials: A
authors.lastname: Pea
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Sergi
authors.forename: Enzo
authors.initials: E
authors.lastname: Manzato
authors.forename: Alessia
authors.initials: A
authors.lastname: Nottegar
authors.forename: Marco
authors.initials: M
authors.lastname: Solmi
authors.forename: Paola
authors.initials: P
authors.lastname: Capelli
authors.forename: Aldo
authors.initials: A
authors.lastname: Scarpa
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000556:secondary* / Q000628:therapy; D014670:Ampulla of Vater / Q000473:pathology*; D003138:Common Bile Duct Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D018450:Disease Progression; D018572:Disease-Free Survival; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D009364:Neoplasm Recurrence, Local; D016017:Odds Ratio; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D011237:Predictive Value of Tests; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome