Systematic review of the clinical significance of lymph node micrometastases of pancreatic adenocarcinoma following surgical resection.
OBJECTIVE
The aim of this study is to perform a systematic review of the clinical impact of lymph node micrometastasis in pancreatic adenocarcinoma following surgical resection.


METHODS
A systematic review was conducted and published literature were searched using "pancreas or pancreatic" and "cancer or carcinoma or neoplasm", and "micrometastasis or micrometastses" in the PubMed, EMBAE, and Web of Science.


RESULTS
Thirteen publications with 726 patients and 3701 lymph nodes were included in this systematic review. The detection method was immunohistochemical stains or polymerase chain reaction. The pooled proportion of patients with positive lymph node micrometastasis was 43.1% (95% Confidence interval (CI) 0.254-0.628). The pooled proportion of positive lymph node micrometastasis (number of positive lymph node micrometastasis/total number of lymph nodes examined) was 10.8% (95% CI 4.8-22.6). Among the conventional H &E negative patients, the reported 5-year survival rates of the patients without lymph node micrometastases vs. those with lymph node micrometastases in the ranged from 50% to 61% and from 0% to 36%, respectively Patients with lymph node micrometastasis showed poorer survival (Hazard ratio 4.29, 95% CI 1.27-14.41).


CONCLUSIONS
The presence of lymph node micrometastasis is associated with poorer survival. Lymph node micrometastasis is applicable to stratify the risk of recurrence and the need for adjuvant therapy of post-resection patients with pancreatic adenocarcinoma in the conventional H & E lymph node negative patients.
Department of Surgery, Korea University College of Medicine, Seoul, South Korea. Electronic address: csbroad@hanmail.net.
Sae Byeol
SB
Choi
Department of Surgery, Korea University College of Medicine, Seoul, South Korea.
Hyung Joon
HJ
Han
Department of Surgery, Korea University College of Medicine, Seoul, South Korea.
Pyoungjae
P
Park
Department of Surgery, Korea University College of Medicine, Seoul, South Korea.
Wan Bae
WB
Kim
Department of Surgery, Korea University College of Medicine, Seoul, South Korea.
Tae-Jin
TJ
Song
Department of Surgery, Korea University College of Medicine, Seoul, South Korea.
Sang Yong
SY
Choi
D000230:Adenocarcinoma / Q000473:pathology* / Q000601:surgery*; D006801:Humans; D008207:Lymphatic Metastasis / Q000473:pathology*; D061206:Neoplasm Micrometastasis; D009364:Neoplasm Recurrence, Local; D010190:Pancreatic Neoplasms / Q000473:pathology* / Q000601:surgery*; D011379:Prognosis; D016019:Survival Analysis
Lymph node metastasis; Lymph node micrometastasis; Pancreatic cancer; Prognosis