Pancreatic cancer: new N staging system accurately predicts outcomes

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Takeaway

  • The absolute number of lymph node metastases is an independent prognostic factor for oncologic outcomes of resected left-sided pancreatic cancer.

Key results

  • pN stage (pN0 vs pN1, 17.5 vs 7.9 mo; P=.001), lymph node ratio (LNR; <0.08 vs ≥0.08, 17.5 vs 4.4 mo; P <0.001), and absolute number of LN metastases (N-LNmet; 0 vs 1 vs ≥2, 17.5 vs 11 vs 6.4 mo; P=.002) were significantly associated with disease-free survival (DFS) in univariate analysis.
  • pN stage (pN0 vs pN1, 35.3 vs 16.7 mo; P=.001), LNR (<0.08 vs ≥0.08, 37.1 vs 15.0 mo; P <.001), and N-LNmet (0 vs 1 vs ≥2, 35.3 vs 18.4 vs 16.4 mo; P=.001) were significantly associated with disease-specific survival (DSS) in univariate analysis.
  • N-LNmet was an independent predictor of DFS (0 vs 1: HR, 2.17 [95% CI, 1.10-4.29, P=.025]; 0 vs ≥2: HR, 2.83 [95% CI, 1.50-5.36, P=.001]) and DSS (0 vs 1: HR, 2.04 [95% CI, 1.01-4.15, P=.049]; 0 vs ≥2: HR, 3.17 [95% CI, 1.64-6.13, P=.001]) in multivariate analysis.

Study design

  • 77 patients who underwent radical pancreatectomy for left-sided pancreatic cancer were retrospectively reviewed for associations between various N staging systems and survival outcomes.

Limitations

  • Retrospective study with small patient sample size.
  • Lymph node area not ana...