Number of involved lymph nodes is important in the prediction of prognosis for primary duodenal adenocarcinoma

Abstract Background The significance of lymph node involvement regarding the prognosis of primary duodenal adenocarcinoma remains controversial. This study aims to evaluate the prognostic accuracy of nodal metastasis using the seventh edition American Joint Committee on Cancer staging system in pati...

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Published in:Journal of the Chinese Medical Association 2012-11, Vol.75 (11), p.573-580
Main Authors: Liang, Tsung-Jung, Wang, Being-Whey, Liu, Shiuh-Inn, Chou, Nan-Hua, Tsai, Cheng-Chung, Chen, I-Shu, Yeh, Ming-Hsin, Chen, Yu-Chia, Chang, Po-Min, Mok, King-Tong
Format: Article
Language:English
Subjects:
Adenocarcinoma - mortality
Adult
Aged
Aged, 80 and over
American Joint Committee on Cancer
duodenal adenocarcinoma
Duodenal Neoplasms - mortality
Female
Humans
Internal Medicine
lymph node metastasis
Lymph Nodes - pathology
Lymphatic Metastasis - pathology
Male
Middle Aged
Prognosis
small bowel
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Summary:Abstract Background The significance of lymph node involvement regarding the prognosis of primary duodenal adenocarcinoma remains controversial. This study aims to evaluate the prognostic accuracy of nodal metastasis using the seventh edition American Joint Committee on Cancer staging system in patients with primary duodenal adenocarcinoma. Methods Between 1993 and 2010, 36 patients who had undergone surgical resection for primary duodenal adenocarcinoma at the Kaohsiung Veterans General Hospital were retrospectively reviewed. Results The median disease-free survival for all patients was 19 months and the median overall survival was 21 months. Lymph node metastases were found in 26 (72%) of the patients, and 14 patients (39%) patients had in excess of three positive lymph nodes (N2). Patients with N2 disease had significantly reduced overall survival, as compared to patients with three or fewer positive lymph nodes (N1; p  = 0.036). In univariate analysis, factors including age >75 years, body weight loss, tumor size ≤4 cm, N2 disease and lymph node ratio >0.4 predicted shorter overall survival. Multivariate analysis demonstrated that N2 and lymph node ratio >0.4 are significant risk factors associated with overall survival ( p  = 0.026 and p  = 0.042 respectively). N2 is also the only independent predictive factor for disease-free survival ( p  = 0.023). Conclusion Subdivision of metastatic lymph nodes into N1 and N2 improves predictive ability. The seventh edition American Joint Committee on Cancer staging system is applicable in the present study with regard to the prediction of the prognosis for primary duodenal adenocarcinoma.
ISSN:1726-4901
1728-7731
DOI:10.1016/j.jcma.2012.08.002