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Prognostic significance of three lymph node staging systems in pancreatic cancer with ≤ 12 and > 12 retrieved lymph nodes

  • 0Department of General Surgery, Department of Hepato-Bilio-Pancreatic Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, No. 1 Da Hua Road, Dong Dan, Beijing, 100730, People's Republic of China.
Updates in Surgery +

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January 10, 2025

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January 10, 2025

View abstract on PubMed

Summary

This summary is machine-generated.

The lymph node ratio (LNR) staging system better predicts pancreatic ductal adenocarcinoma (PDAC) survival than N stage. Combining LNR with negative lymph nodes (NLN) may improve prognostic accuracy, especially for N0 disease.

Area Of Science

  • Oncology
  • Surgical Pathology
  • Cancer Prognostics

Background

  • Accurate lymph node staging is crucial for pancreatic ductal adenocarcinoma (PDAC) prognosis.
  • Existing staging systems, including N stage, negative lymph nodes (NLN), and lymph node ratio (LNR), have varying predictive capabilities.
  • The impact of lymph node retrieval sufficiency on these staging systems remains an area for investigation.

Purpose Of The Study

  • To compare the predictive performance of NLN, LNR, and N stage in PDAC.
  • To evaluate these systems based on the number of retrieved lymph nodes (≤12 vs. >12).
  • To explore the association between these nodal staging systems and cancer-specific survival (CSS) and overall survival (OS).

Main Methods

  • Utilized data from the Surveillance, Epidemiology, and End Results (SEER) database (2004-2020) for PDAC patients.
  • Employed Cox regression to identify independent predictors of CSS and OS.
  • Assessed prognostic ability using Akaike information criterion (AIC) and Harrell's C-index, with Kaplan-Meier and log-rank tests for survival comparisons.

Main Results

  • All three systems (NLN, LNR, N stage) independently predicted CSS and OS.
  • Lower N stage and LNR, and higher NLN, correlated with improved survival.
  • LNR demonstrated superior predictive performance over N stage (lower AIC, higher C-index) irrespective of lymph node retrieval sufficiency.
  • NLN staging showed poor performance overall but was a significant predictor for N0 disease and in subgroup analyses for node-negative patients.

Conclusions

  • LNR staging is a more robust predictor of PDAC survival compared to traditional N stage, regardless of lymph node count.
  • NLN staging has limited utility except for N0 disease, where it is a key prognostic factor.
  • Combining LNR and NLN may provide more precise lymph node staging and prognostic information for PDAC patients than current systems.

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