Number of evaluated lymph nodes and positive lymph nodes, lymph node ratio, and log odds evaluation in early-stage pancreatic ductal adenocarcinoma: numerology or valid indicators of patient outcome?
BACKGROUND
We evaluated the prognostic significance and universal validity of the total number of evaluated lymph nodes (ELN), number of positive lymph nodes (PLN), lymph node ratio (LNR), and log odds of positive lymph nodes (LODDS) in a relatively large and homogenous cohort of surgically treated pancreatic ductal adenocarcinoma (PDAC) patients.


METHODS
Prospectively accrued data were retrospectively analyzed for 282 PDAC patients who had pancreaticoduodenectomy (PD) at our institution. Long-term survival was analyzed according to the ELN, PLN, LNR, and LODDS.


RESULTS
Of these patients, 168 patients (59.5 %) had LN metastasis (N1). Mean ELN and PLN were 13.5 and 1.6, respectively. LN positivity correlated with a greater number of evaluated lymph nodes; positive lymph nodes were identified in 61.4 % of the patients with ELN ≥ 13 compared with 44.9 % of the patients with ELN < 13 (p = 0.014). Median overall survival (OS) and 5-year OS rate were higher in N0 than in N1 patients, 22.4 vs. 18.7 months and 35 vs. 11 %, respectively (p = 0.008). Mean LNR was 0.12; 91 patients (54.1 %) had LNR < 0.3. Among the N1 patients, median OS was comparable in those with LNR ≥ 0.3 vs. LNR < 0.3 (16.7 vs. 14.1 months, p = 0.950). Neither LODDS nor various ELN and PLN cutoff values provided more discriminative information within the group of N1 patients.


CONCLUSIONS
Our data confirms that lymph node positivity strongly reflects PDAC biology and thus patient outcome. While a higher number of evaluated lymph nodes may provide a more accurate nodal staging, it does not have any prognostic value among N1 patients. Similarly, PLN, LNR, and LODDS had limited prognostic relevance.
Department of Surgery, Tel Aviv Sourasky Medical Center, 6th Weitzman St., Tel Aviv, Israel. guyla@tlvmc.gov.il.|Sackler Faculty of Medicine, The Nicholas and Elizabeth Cathedra of Experimental Surgery, Tel Aviv University, Tel Aviv, Israel. guyla@tlvmc.gov.il.
G
G
Lahat
Department of Surgery, Tel Aviv Sourasky Medical Center, 6th Weitzman St., Tel Aviv, Israel.|Sackler Faculty of Medicine, The Nicholas and Elizabeth Cathedra of Experimental Surgery, Tel Aviv University, Tel Aviv, Israel.
N
N
Lubezky
Department of Surgery, Tel Aviv Sourasky Medical Center, 6th Weitzman St., Tel Aviv, Israel.|Sackler Faculty of Medicine, The Nicholas and Elizabeth Cathedra of Experimental Surgery, Tel Aviv University, Tel Aviv, Israel.
F
F
Gerstenhaber
Department of Surgery, Tel Aviv Sourasky Medical Center, 6th Weitzman St., Tel Aviv, Israel.|Sackler Faculty of Medicine, The Nicholas and Elizabeth Cathedra of Experimental Surgery, Tel Aviv University, Tel Aviv, Israel.
E
E
Nizri
Sackler Faculty of Medicine, The Nicholas and Elizabeth Cathedra of Experimental Surgery, Tel Aviv University, Tel Aviv, Israel.
M
M
Gysi
Sackler Faculty of Medicine, The Nicholas and Elizabeth Cathedra of Experimental Surgery, Tel Aviv University, Tel Aviv, Israel.
M
M
Rozenek
Department of Surgery, Tel Aviv Sourasky Medical Center, 6th Weitzman St., Tel Aviv, Israel.|Sackler Faculty of Medicine, The Nicholas and Elizabeth Cathedra of Experimental Surgery, Tel Aviv University, Tel Aviv, Israel.
Y
Y
Goichman
Department of Surgery, Tel Aviv Sourasky Medical Center, 6th Weitzman St., Tel Aviv, Israel.|Sackler Faculty of Medicine, The Nicholas and Elizabeth Cathedra of Experimental Surgery, Tel Aviv University, Tel Aviv, Israel.
I
I
Nachmany
Department of Surgery, Tel Aviv Sourasky Medical Center, 6th Weitzman St., Tel Aviv, Israel.|Sackler Faculty of Medicine, The Nicholas and Elizabeth Cathedra of Experimental Surgery, Tel Aviv University, Tel Aviv, Israel.
R
R
Nakache
Sackler Faculty of Medicine, The Nicholas and Elizabeth Cathedra of Experimental Surgery, Tel Aviv University, Tel Aviv, Israel.|Department of Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
I
I
Wolf
Department of Surgery, Tel Aviv Sourasky Medical Center, 6th Weitzman St., Tel Aviv, Israel.|Sackler Faculty of Medicine, The Nicholas and Elizabeth Cathedra of Experimental Surgery, Tel Aviv University, Tel Aviv, Israel.
J M
JM
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