N0/N1, PNL, or LNR? The Effect of Lymph Node Number on Accurate Survival Prediction in Pancreatic Ductal Adenocarcinoma

Nakul P. Valsangkar, Devon M. Bush, James S. Michaelson, Cristina R. Ferrone, Jennifer A. Wargo, Keith D. Lillemoe, Carlos Fernández-del Castillo, Andrew L. Warshaw, Sarah P. Thayer

Research output: Contribution to journalArticlepeer-review

96 Scopus citations


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 languageEnglish (US)
Pages (from-to)257-266
Number of pages10
JournalJournal of Gastrointestinal Surgery
Issue number2
StatePublished - Feb 2013
Externally publishedYes


  • Lymph node ratio
  • Pancreatic cancer
  • Staging
  • Survival

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology


Dive into the research topics of 'N0/N1, PNL, or LNR? The Effect of Lymph Node Number on Accurate Survival Prediction in Pancreatic Ductal Adenocarcinoma'. Together they form a unique fingerprint.

Cite this