Mirkin KA, et al. - Authors here aimed at determining whether number of examined lymph nodes (eLNs) and lymph node ratio (LNR) impact survival in resected pancreatic cancer. As per findings, in stage I & II pancreatic adenocarcinoma, greater lymph node retrieval could have prognostic value, even in node-negative disease. Lymph node ratio seemed to have an inverse relation with survival and could be useful with suboptimal eLN.

Methods

• Researchers performed a review of the U.S. National Cancer Data Base (2003-2011) to identify patients who underwent initial resection for clinical stage I and II pancreatic adenocarcinoma.
• They performed univariate and multivariate survival analyses.

Results

• Researchers analyzed 14,007 patients; 15.6% had 0-6 eLN, 27.1% 7-12, 13.4% 13-15, and 38.6% > 15 eLN.
• In this study, Median eLN was 11 for pancreaticoduodenectomy, and 14 for distal, total pancreatectomy, or other procedure.
• Significantly improved survival was observed with eLN >15 in both node negative and positive disease (P < 0.001, both).
• Multivariable analysis suggested that 7-12, 13-15, and >15 eLN had improved survival relative to 0-6 eLN (HR 0.87, P < 0.001, HR 0.89, P=0.002, HR 0.82, P < 0.001, respectively).
• They observed that a total of 34.5% of patients had an LNR of 0, 31.5% ≤ 0.2, 20.3% 0.2-0.4, 11.7% 0.4-0.8, and 2.0% had an LNR >0.8.
• In T1-T3 disease, patients with LNR 0 indicated improved survival (P < 0.01).
• In multivariable analysis, higher LNR was negatively associated with survival (LNR 0-0.2: HR 1.44, P < 0.001, LNR 0.2-0.4: HR 1.82, P < 0.001, LNR 0.4-0.8: 2.03, P < 0.001, LNR >0.8, P < 0.001).
• Higher LNR remained an independent predictor of mortality even with suboptimal eLN (eLN ≤6 or ≤12),.