Lymph node metastases in resected pancreatic ductal adenocarcinoma: predictors of disease recurrence and survival

Vicente Morales-Oyarvide; Douglas A. Rubinson; Richard F. Dunne; Margaret M. Kozak; Justin L. Bui; Chen Yuan; Zhi Rong Qian; Ana Babic; Annacarolina Da Silva; Jonathan A. Nowak; Natalia Khalaf; Lauren K. Brais; Marisa W. Welch; Caitlin L. Zellers; Kimmie Ng; Daniel T. Chang; Rebecca A. Miksad; Andrea J. Bullock; Jennifer F. Tseng; Richard S. Swanson; Thomas E. Clancy; David C. Linehan; Jennifer J. Findeis-Hosey; Leona A. Doyle; Jason L. Hornick; Shuji Ogino; Charles S. Fuchs; Aram F. Hezel; Albert C. Koong; Brian M. Wolpin

doi:10.1038/bjc.2017.349

Lymph node metastases in resected pancreatic ductal adenocarcinoma: predictors of disease recurrence and survival

Vicente Morales-Oyarvide, Douglas A. Rubinson, Richard F. Dunne, Margaret M. Kozak, Justin L. Bui, Chen Yuan, Zhi Rong Qian, Ana Babic, Annacarolina Da Silva, Jonathan A. Nowak, Natalia Khalaf, Lauren K. Brais, Marisa W. Welch, Caitlin L. Zellers, Kimmie Ng, Daniel T. Chang, Rebecca A. Miksad, Andrea J. Bullock, Jennifer F. Tseng, Richard S. SwansonThomas E. Clancy, David C. Linehan, Jennifer J. Findeis-Hosey, Leona A. Doyle, Jason L. Hornick, Shuji Ogino, Charles S. Fuchs, Aram F. Hezel, Albert C. Koong, Brian M. Wolpin

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Abstract

BACKGROUND: Few studies have simultaneously assessed the prognostic value of the multiple classification systems for lymph node (LN) metastases in resected pancreatic ductal adenocarcinoma (PDAC).

METHODS: In 600 patients with resected PDAC, we examined the association of LN parameters (AJCC 7th and 8th editions, LN ratio (LNR), and log odds of metastatic LN (LODDS)) with pattern of recurrence and patient survival using logistic regression and Cox proportional hazards regression, respectively. Regression models adjusted for age, sex, margin status, tumour grade, and perioperative therapy.

RESULTS: Lymph node metastases classified by AJCC 7th and 8th editions, LNR, and LODDS were associated with worse disease free-survival (DFS) and overall survival (OS) (all Ptrend<0.01). American Joint Committee on Cancer 8th edition effectively predicted DFS and OS, while minimising model complexity. Lymph node metastases had weaker prognostic value in patients with positive margins and distal resections (both Pinteraction<0.03). Lymph node metastases by AJCC 7th and 8th editions did not predict the likelihood of local disease as the first site of recurrence.

CONCLUSIONS: American Joint Committee on Cancer 8th edition LN classification is an effective and practical tool to predict outcomes in patients with resected PDAC. However, the prognostic value of LN metastases is attenuated in patients with positive resection margins and distal pancreatectomies.

Original language	English (US)
Pages (from-to)	1874-1882
Number of pages	9
Journal	British Journal of Cancer
Volume	117
Issue number	12
DOIs	https://doi.org/10.1038/bjc.2017.349
State	Published - Dec 5 2017

ASJC Scopus subject areas

Oncology
Cancer Research

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Morales-Oyarvide, V., Rubinson, D. A., Dunne, R. F., Kozak, M. M., Bui, J. L., Yuan, C., Qian, Z. R., Babic, A., Da Silva, A., Nowak, J. A., Khalaf, N., Brais, L. K., Welch, M. W., Zellers, C. L., Ng, K., Chang, D. T., Miksad, R. A., Bullock, A. J., Tseng, J. F., ... Wolpin, B. M. (2017). Lymph node metastases in resected pancreatic ductal adenocarcinoma: predictors of disease recurrence and survival. British Journal of Cancer, 117(12), 1874-1882. https://doi.org/10.1038/bjc.2017.349

Morales-Oyarvide, V, Rubinson, DA, Dunne, RF, Kozak, MM, Bui, JL, Yuan, C, Qian, ZR, Babic, A, Da Silva, A, Nowak, JA, Khalaf, N, Brais, LK, Welch, MW, Zellers, CL, Ng, K, Chang, DT, Miksad, RA, Bullock, AJ, Tseng, JF, Swanson, RS, Clancy, TE, Linehan, DC, Findeis-Hosey, JJ, Doyle, LA, Hornick, JL, Ogino, S, Fuchs, CS, Hezel, AF, Koong, AC & Wolpin, BM 2017, 'Lymph node metastases in resected pancreatic ductal adenocarcinoma: predictors of disease recurrence and survival', British Journal of Cancer, vol. 117, no. 12, pp. 1874-1882. https://doi.org/10.1038/bjc.2017.349

@article{beb90ca67f4c47fe97c93d77fbb3d121,

title = "Lymph node metastases in resected pancreatic ductal adenocarcinoma: predictors of disease recurrence and survival",

abstract = "BACKGROUND: Few studies have simultaneously assessed the prognostic value of the multiple classification systems for lymph node (LN) metastases in resected pancreatic ductal adenocarcinoma (PDAC).METHODS: In 600 patients with resected PDAC, we examined the association of LN parameters (AJCC 7th and 8th editions, LN ratio (LNR), and log odds of metastatic LN (LODDS)) with pattern of recurrence and patient survival using logistic regression and Cox proportional hazards regression, respectively. Regression models adjusted for age, sex, margin status, tumour grade, and perioperative therapy.RESULTS: Lymph node metastases classified by AJCC 7th and 8th editions, LNR, and LODDS were associated with worse disease free-survival (DFS) and overall survival (OS) (all Ptrend<0.01). American Joint Committee on Cancer 8th edition effectively predicted DFS and OS, while minimising model complexity. Lymph node metastases had weaker prognostic value in patients with positive margins and distal resections (both Pinteraction<0.03). Lymph node metastases by AJCC 7th and 8th editions did not predict the likelihood of local disease as the first site of recurrence.CONCLUSIONS: American Joint Committee on Cancer 8th edition LN classification is an effective and practical tool to predict outcomes in patients with resected PDAC. However, the prognostic value of LN metastases is attenuated in patients with positive resection margins and distal pancreatectomies.",

author = "Vicente Morales-Oyarvide and Rubinson, {Douglas A.} and Dunne, {Richard F.} and Kozak, {Margaret M.} and Bui, {Justin L.} and Chen Yuan and Qian, {Zhi Rong} and Ana Babic and {Da Silva}, Annacarolina and Nowak, {Jonathan A.} and Natalia Khalaf and Brais, {Lauren K.} and Welch, {Marisa W.} and Zellers, {Caitlin L.} and Kimmie Ng and Chang, {Daniel T.} and Miksad, {Rebecca A.} and Bullock, {Andrea J.} and Tseng, {Jennifer F.} and Swanson, {Richard S.} and Clancy, {Thomas E.} and Linehan, {David C.} and Findeis-Hosey, {Jennifer J.} and Doyle, {Leona A.} and Hornick, {Jason L.} and Shuji Ogino and Fuchs, {Charles S.} and Hezel, {Aram F.} and Koong, {Albert C.} and Wolpin, {Brian M.}",

year = "2017",

month = dec,

day = "5",

doi = "10.1038/bjc.2017.349",

language = "English (US)",

volume = "117",

pages = "1874--1882",

journal = "British Journal of Cancer",

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TY - JOUR

T1 - Lymph node metastases in resected pancreatic ductal adenocarcinoma

T2 - predictors of disease recurrence and survival

AU - Morales-Oyarvide, Vicente

AU - Rubinson, Douglas A.

AU - Dunne, Richard F.

AU - Kozak, Margaret M.

AU - Bui, Justin L.

AU - Yuan, Chen

AU - Qian, Zhi Rong

AU - Babic, Ana

AU - Da Silva, Annacarolina

AU - Nowak, Jonathan A.

AU - Khalaf, Natalia

AU - Brais, Lauren K.

AU - Welch, Marisa W.

AU - Zellers, Caitlin L.

AU - Ng, Kimmie

AU - Chang, Daniel T.

AU - Miksad, Rebecca A.

AU - Bullock, Andrea J.

AU - Tseng, Jennifer F.

AU - Swanson, Richard S.

AU - Clancy, Thomas E.

AU - Linehan, David C.

AU - Findeis-Hosey, Jennifer J.

AU - Doyle, Leona A.

AU - Hornick, Jason L.

AU - Ogino, Shuji

AU - Fuchs, Charles S.

AU - Hezel, Aram F.

AU - Koong, Albert C.

AU - Wolpin, Brian M.

PY - 2017/12/5

Y1 - 2017/12/5

N2 - BACKGROUND: Few studies have simultaneously assessed the prognostic value of the multiple classification systems for lymph node (LN) metastases in resected pancreatic ductal adenocarcinoma (PDAC).METHODS: In 600 patients with resected PDAC, we examined the association of LN parameters (AJCC 7th and 8th editions, LN ratio (LNR), and log odds of metastatic LN (LODDS)) with pattern of recurrence and patient survival using logistic regression and Cox proportional hazards regression, respectively. Regression models adjusted for age, sex, margin status, tumour grade, and perioperative therapy.RESULTS: Lymph node metastases classified by AJCC 7th and 8th editions, LNR, and LODDS were associated with worse disease free-survival (DFS) and overall survival (OS) (all Ptrend<0.01). American Joint Committee on Cancer 8th edition effectively predicted DFS and OS, while minimising model complexity. Lymph node metastases had weaker prognostic value in patients with positive margins and distal resections (both Pinteraction<0.03). Lymph node metastases by AJCC 7th and 8th editions did not predict the likelihood of local disease as the first site of recurrence.CONCLUSIONS: American Joint Committee on Cancer 8th edition LN classification is an effective and practical tool to predict outcomes in patients with resected PDAC. However, the prognostic value of LN metastases is attenuated in patients with positive resection margins and distal pancreatectomies.

AB - BACKGROUND: Few studies have simultaneously assessed the prognostic value of the multiple classification systems for lymph node (LN) metastases in resected pancreatic ductal adenocarcinoma (PDAC).METHODS: In 600 patients with resected PDAC, we examined the association of LN parameters (AJCC 7th and 8th editions, LN ratio (LNR), and log odds of metastatic LN (LODDS)) with pattern of recurrence and patient survival using logistic regression and Cox proportional hazards regression, respectively. Regression models adjusted for age, sex, margin status, tumour grade, and perioperative therapy.RESULTS: Lymph node metastases classified by AJCC 7th and 8th editions, LNR, and LODDS were associated with worse disease free-survival (DFS) and overall survival (OS) (all Ptrend<0.01). American Joint Committee on Cancer 8th edition effectively predicted DFS and OS, while minimising model complexity. Lymph node metastases had weaker prognostic value in patients with positive margins and distal resections (both Pinteraction<0.03). Lymph node metastases by AJCC 7th and 8th editions did not predict the likelihood of local disease as the first site of recurrence.CONCLUSIONS: American Joint Committee on Cancer 8th edition LN classification is an effective and practical tool to predict outcomes in patients with resected PDAC. However, the prognostic value of LN metastases is attenuated in patients with positive resection margins and distal pancreatectomies.

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Lymph node metastases in resected pancreatic ductal adenocarcinoma: predictors of disease recurrence and survival

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