Abstract
Introduction: We evaluated the prognostic accuracy of LN variables (N0/N1), numbers of positive lymph nodes (PLN), and lymph node ratio (LNR) in the context of the total number of examined lymph nodes (ELN). Methods: Patients from SEER and a single institution (MGH) were reviewed and survival analyses performed in subgroups based on numbers of ELN to calculate excess risk of death (hazard ratio, HR). Results: In SEER and MGH, higher numbers of ELN improved the overall survival for N0 patients. The prognostic significance (N0/N1) and PLN were too variable as the importance of a single PLN depended on the total number of LN dissected. LNR consistently correlated with survival once a certain number of lymph nodes were dissected (≥13 in SEER and ≥17 in the MGH dataset). Conclusions: Better survival for N0 patients with increasing ELN likely represents improved staging. PLN have some predictive value but the ELN strongly influence their impact on survival, suggesting the need for a ratio-based classification. LNR strongly correlates with outcome provided that a certain number of lymph nodes is evaluated, suggesting that the prognostic accuracy of any LN variable depends on the total number of ELN.
Original language | English (US) |
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Pages (from-to) | 257-266 |
Number of pages | 10 |
Journal | Journal of Gastrointestinal Surgery |
Volume | 17 |
Issue number | 2 |
DOIs | |
State | Published - Feb 2013 |
Externally published | Yes |
Keywords
- Lymph node ratio
- Pancreatic cancer
- Staging
- Survival
ASJC Scopus subject areas
- Surgery
- Gastroenterology