title: Which patients with para-aortic lymph node (LN16) metastasis will truly benefit from curative pancreaticoduodenectomy for pancreatic head cancer?
abstract: In patients with cancer of the pancreatic head, metastasis to para-aortic lymph nodes (LN16) is considered distant metastasis and a poor prognostic marker. However, the incidence of LN16 involvement in pancreatic head cancer is high, and it is unclear whether all such patients have poor surgical outcomes. We investigated the significance of LN16 involvement in resectable pancreatic head cancer by retrospectively analyzing 579 ductal adenocarcinoma patients treated with para-aortic lymph node dissection at two high-volume Chinese centers. Depending upon tumor location, the incidence of LN16 metastasis and the correlation between LN16 involvement and involvement of Group 1 or 2 lymph nodes significantly differed. Metastasis to LN16 indicated a high serum tumor burden and a poor prognosis, though LN16-positive patients with a lymph node ratio (LNR) < 0.25 may still benefit from radical surgery. Survival analysis of LN16-positive patients with resectable pancreatic head cancer revealed that tumor size, tumor differentiation, and tumor location are independent prognostic factors. We also found that preoperative serum CA125 < 18.62 U/ml and the level of JAK2 signaling are both indicators of who may benefit from curative surgical resection for pancreatic head cancer.
authors.affiliation: Department of Pancreatic and Hepatobiliary Surgery, Fudan University Shanghai Cancer Center, Shanghai, P.R. China.|Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, P.R. China.|Pancreatic Cancer Institute, Fudan University, Shanghai, P.R. China.
authors.forename: Chen
authors.initials: C
authors.lastname: Liu
authors.affiliation: Department of Pancreatic and Hepatobiliary Surgery, Fudan University Shanghai Cancer Center, Shanghai, P.R. China.|Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, P.R. China.|Pancreatic Cancer Institute, Fudan University, Shanghai, P.R. China.
authors.forename: Yu
authors.initials: Y
authors.lastname: Lu
authors.affiliation: Department of Pancreatic and Hepatobiliary Surgery, Fudan University Shanghai Cancer Center, Shanghai, P.R. China.|Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, P.R. China.|Pancreatic Cancer Institute, Fudan University, Shanghai, P.R. China.
authors.forename: Guopei
authors.initials: G
authors.lastname: Luo
authors.affiliation: Department of Pancreatic and Hepatobiliary Surgery, Fudan University Shanghai Cancer Center, Shanghai, P.R. China.|Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, P.R. China.|Pancreatic Cancer Institute, Fudan University, Shanghai, P.R. China.
authors.forename: He
authors.initials: H
authors.lastname: Cheng
authors.affiliation: Department of Pancreatic and Hepatobiliary Surgery, Fudan University Shanghai Cancer Center, Shanghai, P.R. China.|Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, P.R. China.|Pancreatic Cancer Institute, Fudan University, Shanghai, P.R. China.
authors.forename: Meng
authors.initials: M
authors.lastname: Guo
authors.affiliation: Department of Pancreatic and Hepatobiliary Surgery, Fudan University Shanghai Cancer Center, Shanghai, P.R. China.|Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, P.R. China.|Pancreatic Cancer Institute, Fudan University, Shanghai, P.R. China.
authors.forename: Zuqiang
authors.initials: Z
authors.lastname: Liu
authors.affiliation: Department of Pancreatic and Hepatobiliary Surgery, Fudan University Shanghai Cancer Center, Shanghai, P.R. China.|Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, P.R. China.|Pancreatic Cancer Institute, Fudan University, Shanghai, P.R. China.
authors.forename: Jin
authors.initials: J
authors.lastname: Xu
authors.affiliation: Department of Pancreatic and Hepatobiliary Surgery, Fudan University Shanghai Cancer Center, Shanghai, P.R. China.|Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, P.R. China.|Pancreatic Cancer Institute, Fudan University, Shanghai, P.R. China.
authors.forename: Jiang
authors.initials: J
authors.lastname: Long
authors.affiliation: Department of Pancreatic and Hepatobiliary Surgery, Fudan University Shanghai Cancer Center, Shanghai, P.R. China.|Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, P.R. China.|Pancreatic Cancer Institute, Fudan University, Shanghai, P.R. China.
authors.forename: Liang
authors.initials: L
authors.lastname: Liu
authors.affiliation: Department of Pancreatic Surgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, P.R. China.
authors.forename: Deliang
authors.initials: D
authors.lastname: Fu
authors.affiliation: Department of Pancreatic and Hepatobiliary Surgery, Fudan University Shanghai Cancer Center, Shanghai, P.R. China.|Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, P.R. China.|Pancreatic Cancer Institute, Fudan University, Shanghai, P.R. China.
authors.forename: Quanxing
authors.initials: Q
authors.lastname: Ni
authors.affiliation: Department of Medicine, Department of Surgery, The University of Oklahoma Health Sciences Center, Stanton L. Young Biomedical Research Center, Oklahoma City, USA.
authors.forename: Min
authors.initials: M
authors.lastname: Li
authors.affiliation: Department of Pancreatic and Hepatobiliary Surgery, Fudan University Shanghai Cancer Center, Shanghai, P.R. China.|Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, P.R. China.|Pancreatic Cancer Institute, Fudan University, Shanghai, P.R. China.
authors.forename: Xianjun
authors.initials: X
authors.lastname: Yu
mesh_terms: D000328:Adult; D000368:Aged; D014408:Biomarkers, Tumor / Q000032:analysis; D018394:CA-125 Antigen / Q000378:metabolism; D021441:Carcinoma, Pancreatic Ductal / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D053614:Janus Kinase 2 / Q000378:metabolism; D053208:Kaplan-Meier Estimate; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis / Q000473:pathology*; D008297:Male; D008565:Membrane Proteins / Q000378:metabolism; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D016577:Pancreaticoduodenectomy; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D014408:Biomarkers, Tumor; D018394:CA-125 Antigen; C451759:MUC16 protein, human; D008565:Membrane Proteins; C507924:JAK2 protein, human; D053614:Janus Kinase 2
keywords: lymphadenectomy; metastasis; pancreatic cancer; para-aortic lymph node; prognosis