Pancreatic cancer metastatic to a limited number of lymph nodes has no impact on outcome.
The purpose of this study was to determine the association of the extent of metastatic lymph node involvement with survival in pancreatic cancer.



This is a retrospective review of a prospectively maintained database of patients who underwent resection for pancreatic adenocarcinoma, 1999-2011.



165 patients were identified and divided into 3 groups based on the number of positive lymph nodes - 0 (group A), 1-2 (B), >3 (C). Each group had 55 patients. Those in group C were more likely to have a higher T stage, poorly differentiated grade, lymphovascular invasion (LVI), higher mean intraoperative blood loss, positive margins, tumor location involving the uncinate process, and a higher likelihood of undergoing a pancreaticoduodenectomy. Median overall survival (OS) for group A, B and C was 25.5 months (mo), 21 mo and 12.3 mo, respectively (p < 0.001). No survival difference was noted for survival between groups A and B (p = 0.86). The ratio of involved lymph nodes <0.2 was predictive of improved survival (p < 0.001).



Resected pancreatic cancer patients with only 1-2 positive lymph nodes or less than 20% involvement have a similar prognosis to patients without nodal disease. Current staging should consider stratification based on the extent of nodal involvement.
Department of Surgical Oncology, Roswell Park Cancer Institute, Buffalo, NY 14263, USA.
Scott
S
Baldwin
Department of Surgical Oncology, Roswell Park Cancer Institute, Buffalo, NY 14263, USA. Electronic address: Moshim.Kukar@roswellpark.org.
Moshim
M
Kukar
Department of Surgical Oncology, Roswell Park Cancer Institute, Buffalo, NY 14263, USA.
Emmanuel
E
Gabriel
Department of Biostatistics, Roswell Park Cancer Institute, Buffalo, NY 14263, USA.
Kristopher
K
Attwood
Department of Surgical Oncology, Roswell Park Cancer Institute, Buffalo, NY 14263, USA.
Neal
N
Wilkinson
Department of Surgical Oncology, Roswell Park Cancer Institute, Buffalo, NY 14263, USA.
Steven N
SN
Hochwald
Department of Surgical Oncology, Roswell Park Cancer Institute, Buffalo, NY 14263, USA.
Boris
B
Kuvshinoff
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D021441:Carcinoma, Pancreatic Ductal / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D016208:Databases, Factual; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D010180:Pancreatectomy / Q000009:adverse effects / Q000401:mortality; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome