Prognostic Impact of Para-Aortic Lymph Node Micrometastasis in Pancreatic Ductal Adenocarcinoma

Background It is still unclear whether micrometastasis of para-aortic lymph nodes (PALNs) in pancreatic ductal adenocarcinoma (PDAC) is tantamount to PALN metastasis detected by hematoxylin and eosin (HE) staining. Methods A total of 242 patients with PDAC who underwent radical pancreatectomy with P...

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Bibliographic Details
Published in:Annals of surgical oncology 2016-06, Vol.23 (6), p.2019-2027
Main Authors: Komo, Toshiaki, Murakami, Yoshiaki, Kondo, Naru, Uemura, Kenichiro, Hashimoto, Yasushi, Nakagawa, Naoya, Urabe, Kazuhide, Takahashi, Shinya, Sueda, Taijiro
Format: Article
Language:English
Subjects:
Adult
Aged
Aged, 80 and over
Carcinoma, Pancreatic Ductal - secondary
Carcinoma, Pancreatic Ductal - surgery
Female
Follow-Up Studies
Humans
Lymph Nodes - pathology
Lymph Nodes - surgery
Lymphatic Metastasis
Male
Medicine
Medicine & Public Health
Middle Aged
Oncology
Pancreatectomy - mortality
Pancreatic Neoplasms
Pancreatic Neoplasms - pathology
Pancreatic Neoplasms - surgery
Pancreatic Tumors
Prognosis
Prospective Studies
Retrospective Studies
Surgery
Surgical Oncology
Survival Rate
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Summary:Background It is still unclear whether micrometastasis of para-aortic lymph nodes (PALNs) in pancreatic ductal adenocarcinoma (PDAC) is tantamount to PALN metastasis detected by hematoxylin and eosin (HE) staining. Methods A total of 242 patients with PDAC who underwent radical pancreatectomy with PALN dissection were eligible for this study. Micrometastasis in PALNs was evaluated by CAM 5.2 immunohistochemistry. The relationship between PALN status and overall survival (OS) was analyzed. Results Of the 242 enrolled patients, 25 (10 %) had PALN metastasis detected by HE (PALN HE-positive), and 21 (9 %) had PALN micrometastasis not detected by HE but identified by CAM 5.2 immunohistochemistry. Univariate analysis revealed that patients with PALN micrometastasis ( p = .004) and PALN HE positivity ( p = .003) had a significantly shorter OS than those without PALN metastasis, whereas no significant difference was observed between the two former groups ( p = .874). In multivariate analysis, lack of adjuvant chemotherapy (hazard ratio [HR] 2.43, p < .001), PALN micrometastasis (HR 1.89; p = .046), and PALN HE-positivity (HR 1.89, p = .023) were identified as independent risk factors for poor prognosis. Within a subset of 46 patients with PALN HE-positivity or micrometastasis, lack of adjuvant chemotherapy was independently associated with poor OS (HR 2.58. p = .029). Conclusions The prognosis of patients with PALN micrometastasis was extremely poor as well as HE-positive PALNs. However, postoperative adjuvant chemotherapy may contribute to improving the prognosis of PDAC patients with PALN metastasis.
ISSN:1068-9265
1534-4681
DOI:10.1245/s10434-016-5120-8