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29.04.2019 | Pancreatic Tumors | Ausgabe 7/2019

Annals of Surgical Oncology 7/2019

A Single-Institution Validation Study of Lymph Node Staging By the AJCC 8th Edition for Patients with Pancreatic Head Cancer: A Proposal to Subdivide the N2 Category

Zeitschrift:
Annals of Surgical Oncology > Ausgabe 7/2019
Autoren:
MD Daisuke Asano, MD Satoshi Nara, MD Yoji Kishi, MD Minoru Esaki, MD Nobuyoshi Hiraoka, MD Minoru Tanabe, MD Kazuaki Shimada
Wichtige Hinweise

Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1245/​s10434-019-07390-z) contains supplementary material, which is available to authorized users.

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Abstract

Background

According to the revised staging of the American Joint Committee on Cancer, 8th edition (AJCC8), the N category in pancreatic ductal adenocarcinoma is classified as N0 (0), N1 (1–3), and N2 (≥ 4) based on the number of metastatic lymph nodes (LNs). This study aimed to validate this classification and analyze cutoff values of metastatic LN numbers.

Methods

Patients with pancreatic head ductal adenocarcinoma who underwent pancreaticoduodenectomy at our institution between 2005 and 2016 without preoperative therapy were retrospectively analyzed. The patients were staged by AJCC8, and prognostic analyses were performed. The best cutoff value for the metastatic LN number was determined by the minimum P value approach.

Results

In 228 of 309 patients, LN metastases were found (median number of examined LNs, 41). The median survival time (MST) was 56 months in the N0 group, 34 months in the N1 group, and 20 months in the N2 group (N0 vs N1: P = 0.023; N1 vs N2: P < 0.001). The best cutoff number of metastatic LNs was 4 for patients with LN metastases and 7 for patients with N2 disease. The MST for patients with four to six positive nodes (N2a) was significantly longer than for those with seven or more positive nodes (N2b) (24.0 vs 19.1 months: P = 0.012). For N2b patients, conventional adjuvant chemotherapy did not show survival benefits (P = 0.133), and overall survival did not differ significantly from that for patients with para-aortic LN metastasis (P = 0.562).

Conclusion

The N staging of AJCC8 was valid. Clinicians should regard N2b as similar to distant LN metastasis, and more intensive adjuvant therapy may be indicated for this group.

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Zusatzmaterial
Supplementary material 1 (DOCX 55 kb)
10434_2019_7390_MOESM1_ESM.docx
Supplementary material 2 (DOCX 50 kb)
10434_2019_7390_MOESM2_ESM.docx
Literatur
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