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Which patients with para-aortic lymph node (LN16) metastasis will truly benefit from curative pancreaticoduodenectomy for pancreatic head cancer?

ABSTRACT: In patients with cancer of the pancreatic head, metastasis to para-aortic lymph nodes (LN16) is considered distant metastasis and a poor prognostic marker. However, the incidence of LN16 involvement in pancreatic head cancer is high, and it is unclear whether all such patients have poor surgical outcomes. We investigated the significance of LN16 involvement in resectable pancreatic head cancer by retrospectively analyzing 579 ductal adenocarcinoma patients treated with para-aortic lymph node dissection at two high-volume Chinese centers. Depending upon tumor location, the incidence of LN16 metastasis and the correlation between LN16 involvement and involvement of Group 1 or 2 lymph nodes significantly differed. Metastasis to LN16 indicated a high serum tumor burden and a poor prognosis, though LN16-positive patients with a lymph node ratio (LNR) < 0.25 may still benefit from radical surgery. Survival analysis of LN16-positive patients with resectable pancreatic head cancer revealed that tumor size, tumor differentiation, and tumor location are independent prognostic factors. We also found that preoperative serum CA125 < 18.62 U/ml and the level of JAK2 signaling are both indicators of who may benefit from curative surgical resection for pancreatic head cancer.

SUBMITTER: Liu C

PROVIDER: S-EPMC5045387 | biostudies-literature | 2016 May

REPOSITORIES: biostudies-literature

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Which patients with para-aortic lymph node (LN16) metastasis will truly benefit from curative pancreaticoduodenectomy for pancreatic head cancer?

Liu Chen C Lu Yu Y Luo Guopei G Cheng He H Guo Meng M Liu Zuqiang Z Xu Jin J Long Jiang J Liu Liang L Fu Deliang D Ni Quanxing Q Li Min M Yu Xianjun X

Oncotarget 20160501 20

In patients with cancer of the pancreatic head, metastasis to para-aortic lymph nodes (LN16) is considered distant metastasis and a poor prognostic marker. However, the incidence of LN16 involvement in pancreatic head cancer is high, and it is unclear whether all such patients have poor surgical outcomes. We investigated the significance of LN16 involvement in resectable pancreatic head cancer by retrospectively analyzing 579 ductal adenocarcinoma patients treated with para-aortic lymph node dis ...[more]

PMID: 27081079

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Project description:Background and objectives In patients with colorectal cancer and clinically suspected para-aortic lymph node metastasis, the survival benefit of para-aortic lymphadenectomy is unknown. We conducted a meta-analysis and systematic review to investigate it. Methods PubMed, Web of Science, and EMBASE were searched until January 2000 to April 2022 to identify studies reporting overall survivals, complication rates, and hazard ratios of prognostic factors in patients with colorectal cancer undergoing para-aortic lymphadenectomy, and those data were pooled. Results Twenty retrospective studies (1021 patients undergoing para-aortic lymphadenectomy) met the inclusion criteria. Meta-analysis indicates that participants undergoing para-aortic lymphadenectomy were associated with 5-year survival benefit, compared to those not receiving para-aortic lymphadenectomy (odds ratio = 3.73, 95% confidence interval: 2.05–6.78), but there was no significant difference in complication rate (odds ratio = 0.97, 95% confidence interval: 0.46–2.08). Further analysis of para-aortic lymphadenectomy group showed that 5-year survival of the positive group with pathologically para-aortic lymph node metastasis was lower than that of the negative group (odds ratio = 0.19, 95% confidence interval: 0.11–0.31). Moreover, complete resection (odds ratio = 5.26, 95% confidence interval: 2.02–13.69), para-aortic lymph node metastasis (≤4) (hazard ratio = 1.88, 95% confidence interval: 0.97–3.62), and medium-high differentiation (hazard ratio = 2.98, 95% confidence interval: 1.48–5.99) were protective factors for survival. Preoperative extra-retroperitoneal metastasis was associated with poorer relapse-free survival (hazard ratio = 1.85, 95% confidence interval: 1.10–3.10). Conclusion Para-aortic lymphadenectomy had promising clinical efficacy in prolonging survival rather than complication rate in patients with colorectal cancer and clinically diagnostic para-aortic lymph node metastasis. Further prospective studies should be performed. Trial registration PROSPERO: CRD42022379276. Supplementary Information The online version contains supplementary material available at 10.1186/s12957-023-02908-y.

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Which patients with para-aortic lymph node (LN16) metastasis will truly benefit from curative pancreaticoduodenectomy for pancreatic head cancer?

Publications

Which patients with para-aortic lymph node (LN16) metastasis will truly benefit from curative pancreaticoduodenectomy for pancreatic head cancer?

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