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The value of the lymph node ratio and total number of lymph nodes examined for resected pancreatic signet ring cell carcinoma:a retrospective cohort study

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Journal of Pancreatology 2022年第2期5卷 87-95页

作者： Chao Ren Feng Xue Yinying Wu Zheng Wang Department of Hepatobiliary and Pancreatic Surgery The Affiliated Jinhua Hospital of Zhejiang University School of MedicineJinhuaChina Department of Hepatobiliary Surgery of the First Affiliated Hospital of Xi’an Jiaotong University Xi’anChina Department of Medical Oncology of the First Affiliated Hospital of Xi’an Jiaotong University Xi’anChina

Background:Pancreatic signet ring cell carcinoma(SRCC)is an exceedingly rare histological subtype of pancreatic cancer.Previous studies have focused on the trends of incidence and independent predictors of pancreatic SRCC.Our objectives of the study were to analyze the prognostic value of the lymph node ratio(LNR)and to explore the minimal number of lymph nodes examined to accurately evaluate the N stage in resected pancreatic SRCC.Method:We analyzed 120 patients diagnosed from January 1,1990,to December 31,2016,constituted the study cohort from the Surveillance,Epidemiology,and End Results(SEER)registry.We calculated the overall survival(OS)of these patients by using a Kaplan–Meier analysis.The Kaplan–Meier analysis was used to analyze the influence of various factors on the prognosis of patients in the univariate analysis.The multivariate Cox analysis were applied to find independent prognostic factors of patients with pancreatic SRCC.Receiver-operating characteristic curve(ROC)analysis to investigate the discriminatory ability of the total number of lymph nodes examined(TNLE)relative to whether lymph node metastasis was present.Results:The median number of lymph nodes examined among 120 patients with resected pancreatic SRCC was 14(interquartile range:6.25–20.0).According to the univariate analysis of OS,age,grade,chemotherapy,LNR,and TNLE were significantly different(Plymph node metastasis(Area under curve(AUC):0.656,95%confidence interval:0.564–0.741,Youden index:0.2533,sensitivity:78.67%,specificity:46.67%,P=.003).Conclusion:Our study indicated that the LNR was a valuable independent prognostic factor for resected pancreatic SRCC.Regional lymphadenectomy of at

关键词： Independent factor lymph node ratio Pancreatic signet ring cell carcinoma SEER database Total number of lymph nodes examined

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Neoadjuvant chemoradiation is associated with decreased lymph node ratio in borderline resectable pancreatic cancer:A propensity score matched analysis

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Hepatobiliary & Pancreatic Diseases International 2021年第1期20卷 74-79页

作者： June S Peng Gareth Morris-Stiff Noaman S Ali Jane Wey Sricharan Chalikonda Kevin M El-Hayek R Matthew Walsh Department of Surgery The Pennsylvania State UniversityCollege of MedicineHersheyPA 17033-0850USA Department of General Surgery Digestive Disease and Surgery InstituteCleveland Clinic FoundationClevelandOH 44195-0001USA

Background:lymph node ratio(LNR)and margin status have prognostic significance in pancreatic cancer.Herein we examined the pathologic and clinical outcomes in patients with borderline resectable pancreatic cancer(BRPC)following neoadjuvant therapy(NAT)and pancreaticoduodenectomy.Methods:Patients who underwent treatment between January 1,2012 and June 30,2017 were included.Sequential patients in the BRPC group were compared to a propensity score matched cohort of patients with radiographically resectable pancreatic cancer who underwent upfront surgical resection.The BRPC group was also compared to sequential patients with radiographically resectable pancreatic cancer who required vein resection(VR)during upfront surgery.Results:There were 50 patients in the BRPC group,50 patients in the matched control group,and 38 patients in the VR group.Negative margins(R0)were seen in 72%,64%,and 34%of the BRPC,control,and VR groups,respectively(P=0.521 for BRPC vs.control;P=0.002 for BRPC vs.VR),with 24%of the BRPC group requiring a vascular resection.Nodal stage was N0 in 64%,20%,and 18%of the BRPC,control,and VR groups,respectively(P<0.001 for BRPC vs.control or VR).When nodal status was stratified into four groups(N0,or LNR≤0.2,0.2–0.4,≥0.4),the BRPC group had a more favorable distribution(P<0.001).The median overall survival were 28.8,38.6,and 19.0 months for the BRPC,control,and VR groups,respectively(log-rank P=0.096).Conclusions:NAT in BRPC was associated with more R0 and N0 resections and lower LNR compared to patients undergoing upfront resection for resectable disease.

关键词： Neoadjuvant therapy lymph node ratio Pancreatic cancer Borderline resectable Vein resection

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Effect of the number of positive lymph nodes and lymph node ratio on prognosis of patients after resection of pancreatic adenocarcinoma

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Hepatobiliary & Pancreatic Diseases International 2014年第6期13卷 634-641页

作者： Zu-Qiang Liu Zhi-Wen Xiao Guo-Pei Luo Liang Liu Chen Liu Jin Xu Jiang Long Quan-Xing Ni Xian-Jun Yu Department of Pancreatic and Hepatobiliary Surgery Fudan University Shanghai Cancer Center Department of Oncology Shanghai Medical College Fudan University Pancreatic Cancer Institute Fudan University

BACKGROUND： The prognostic factors related to lymph node involvement [lymph node status, the number of positive lymph nodes, lymph node ratio （LNR）] and the number of nodes evaluated in patients with pancreatic adenocarcinoma after pancreatectomy are poorly defined. METHODS： A total of 167 patients who had undergone resection of pancreatic adenocarcinoma from February 2010 to August 2011 were included in this study. Histological examination was performed to evaluate the tumor differentiation and lymph node involvement. Univariate and multivariate analyses were made to determine the relationship between the variables related to nodal involvement and the number of nodes and survival. RESULTS： The median number of total nodes examined was 10 （range 0-44） for the entire cohort. The median number of total nodes examined in node-negative （pN0） patients was similar to that in node-positive （pN1） patients. Patients with pN1 diseases had significantly worse survival than those with pN0 ones （P=0.000）. Patients with three or more positive nodes had a poorer prognosis compared with those with the negative nodes （P=0.000）. The prognosis of the patients with negative nodes was similar to that of those with one to two positive nodes （P=0.114）. The median survival of patients with an LNR ≥0.4 was shorter than that of patients with an LNR 〈0.4 in the pN1 cohort （P=0.014）. No significance was found between the number of total nodes examined and the prognosis, regardless of the cutoff of 10 or 12 and in the entire cohort or the pN0 and pN1 groups. Based on the multivariate analysis of the entire cohort and the pN1 group, the nodal status, the number of positive nodes and the LNR were all associated with survival. CONCLUSIONS： In addition to the nodal status, the number of positive nodes and the LNR can serve as comprehensive factors for the evaluation of nodal involvement. This approach may be more effective for predicting the survival of patients with pancreatic adenocarcinoma after pancreatectomy.

关键词： lymph node status lymph node ratio number of positive nodes number of total nodes examined pancreatic adenocarcinoma pancreatectomy

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Different lymph node staging systems for predicting the prognosis of colorectal neuroendocrine neoplasms

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World Journal of Gastrointestinal Oncology 2024年第5期16卷 1745-1755页

作者： Yuan-Yi Zhang Yue-Wei Cai Xia Zhang Department of Pathology Zhaoqing Medical CollegeZhaoqing 526020Guangdong ProvinceChina Department of Emergency Zhaoqing Second People’s HospitalZhaoqing 526020Guangdong ProvinceChina Department of Pathology and Physiology Zhaoqing Medical CollegeZhaoqing 526020Guangdong ProvinceChina

BACKGROUND Colorectal neuroendocrine neoplasms(NENs)are a rare malignancy that primarily arises from the diffuse distribution of neuroendocrine cells in the colon and rectum.Previous studies have pointed out that the status of lymph node may be used to predict the prognosis.AIM To investigate the predictive values of lymph node ratio(LNR),positive lymph node(PLN),and log odds of PLNs(LODDS)staging systems on the prognosis of colorectal NENs treated surgically,and compare their predictive values.METHODS This cohort study included 895 patients with colorectal NENs treated surgically from the Surveillance,Epidemiology,and End Results database.The endpoint was mortality of patients with colorectal NENs treated surgically.X-tile software was utilized to identify most suitable thresholds for categorizing the LNR,PLN,and LODDS.Participants were selected in a random manner to form training and testing sets.The prognosis of surgically treating colorectal NENs was examined using multivariate cox analysis to assess the associations of LNR,PLN,and LODDS with the prognosis of colorectal NENs.C-index was used for assessing the predictive effectiveness.We conducted a subgroup analysis to explore the different lymph node staging systems’predictive values.RESULTS After adjusting all confounding factors,PLN,LNR and LODDS staging systems were linked with mortality in patients with colorectal NENs treated surgically(P<0.05).We found that LODDS staging had a higher prognostic value for patients with colorectal NENs treated surgically than PLN and LNR staging systems.Similar results were obtained in the different G staging subgroup analyses.Furthermore,the area under the receiver operating characteristic curve values for LODDS staging system remained consistently higher than those of PLN or LNR,even at the 1-,2-,3-,4-,5-and 6-year follow-up periods.CONCLUSION LNR,PLN,and LODDS were found to significantly predict the prognosis of patients with colorectal NENs treated surgically.

关键词： Positive lymph node lymph node ratio Log odds of positive lymph nodes Prognosis Colorectal neuroendocrine neoplasms

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Prognostic impact of number of examined lymph nodes on survival of patients with appendiceal neuroendocrine tumors

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World Journal of Clinical Cases 2022年第30期10卷 10906-10920页

作者： Rui Du Jiang-Wei Xiao Department of Gastrointestinal Surgery The First Affiliated Hospital of Chengdu Medical CollegeChengdu 610500Sichuan ProvinceChina

BACKGROUND The prognosis of patients with appendiceal neuroendocrine tumors(ANETs) is related to lymph node(LN) metastasis and other factors.However,it is unclear how the number of examined LNs(ELNs) impact on survival.AIM To determine the factors affecting the cancer-specific survival(CSS) of patients with ANET and to evaluate the impact of the number of ELNs on survival.METHODS A total of 4583 ANET patients were analyzed in the Surveillance,Epidemiology,and End Results database.Univariate survival analysis was used to identify factors related to survival and the optimal number of ELNs and lymph node ratio(LNR) were determined by the Kaplan–Meier method.The survival difference was determined by CSS.RESULTS Except for sex,the other factors,such as age,year,race,grade,histological type,stage,tumor size,ELNs,LNR,and surgery type,were associated with prognosis.The 3-,5-,and 10-year CSS rates of ANET patients were 91.2%,87.5,and 81.7%,respectively(median follow-up period of 31 mo and range of 0-499 mo).There was no survival difference between the two surgery types,namely,local resection and colectomy or greater,in both stratifications of tumor size ≥ 2 cm(P = 0.523)and nodenegative patients,and node-positive patients,respectively.CSS rates of patients with a larger number of ELNs were significantly improved(≤ 10 vs ≥ 11,χ~2 =20.303,P < 0.001;≤ 6 vs ≥ 7,χ~2 = 11.569,P < 0.001;≤ 17 vs ≥ 18,χ~2 = 21.990,P < 0.001;respectively).ANET patients with an LNR value ≤ 0.16 were more likely to have better survival than those with values of 0.17-0.48(χ~2 = 48.243,P < 0.001) and 0.49-1(χ~2 = 168.485,P < 0.001).CONCLUSION ANET ≥ 2 cm are more likely to develop LN metastasis.At least 11 ELNs are required to better evaluate the prognosis.For patients with positive LN metastasis,18 or more LNs need to be det

关键词： Appendiceal neoplasm Neuroendocrine tumors Carcinoid tumor lymph node dissection lymph node ratio Survival analysis

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A homogenized approach to classify advanced gastric cancer patients with limited and adequate number of pathologically examined lymph nodes

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Cancer Communications 2019年第1期39卷 303-313页

作者： Sharvesh Raj Seeruttun Lipu Xu Fangwei Wang Xiaodong Yi Cheng Fang Zhimin Liu Wei Wang Zhiwei Zhou Department of Gastric Surgery State Key Laboratory of Oncology in South ChinaCollaborative Innovation Center for Cancer MedicineSun Yat-sen University Cancer Center651 Dongfeng Road EastGuangzhou 510060GuangdongP.R.China Department of Surgical Oncology Affiliated Lu’an Hospital of Anhui Medical UniversityLu’an 237005AnhuiP.R.China

Background:The prognosis of gastric cancer patients with a limited number of pathologically examined lymph nodes(eLN,<16)is dismal compared to those with adequately eLN(≥16),yet they are still classified within the s... 详细信息

Background:The prognosis of gastric cancer patients with a limited number of pathologically examined lymph nodes(eLN,node-metastasis(TNM)clas-sification were stratified into a Limited and Adequate eLN cohort based on their number of pathologically examined LNs.The statistical differences between the 5-year overall survival(OS)rates of both cohorts were determined and based on which,patients from the Limited eLN cohort were re-classified to a proposed modified nodal(N′)and TNM(TN′M)classification,by matching their survival rates with those of the Adequate eLN cohort.The prognostic perfor-mance of the N′and TN′M classification was then compared to a formulated lymph-node-ratio-based nodal classifica-tion,in addition to the 8th AJCC N and TNM classification.Results:Significant heterogeneous differences in 5-year OS between patients from the Limited and Adequate eLN cohort of the same nodal subgroups were identified(all Plymph-node-ratio classification(Akaike information criterion values[AIC]:12,276 vs.12,358 vs.12,283,respectively).The TN′M classification also demonstrated superior

关键词： Advanced gastric cancer Limited lymph nodes Adequate lymph nodes R0 gastrectomy AJCC Eighth edition Modified classification Akaike information criterion lymph node ratio Prognosis

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Retrieved lymph nodes from different anatomic groups in gastric cancer:a proposed optimal number,comparison with other nodal classification strategies and its impact on prognosis

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Cancer Communications 2019年第1期39卷 447-458页

作者： Siwei Pan Pengliang Wang Yanan Xing Kai Li Zhenning Wang Huimian Xu Zhi Zhu Department of Surgical Oncology The First Affiliated Hospital of China Medical UniversityNorth Nanjing Street 155Shenyang 110001LiaoningP.R.China

Background:The optimal number of retrieved lymph nodes(LNs)in gastric cancer(GC)is still debatable and previ-ous studies proposing new classification alternatives mostly focused on the number of retrieved LNs without proper consideration on the anatomic nodal groups’location.Here,we assessed the impact of retrieved LNs from different nodal location groups on the survival of GC patients.Methods:Stage I-III gastric cancer patients who had radical gastrectomy were investigated.LN grouping was deter-mined according to the 13th edition of the JCGC.The optimal cut-off values of retrieved LNs in different LN groups(Group 1 and 2)were calculated,based on which a proposed nodal classification(rN)simultaneously accounting the optimal number and location of retrieved LNs was proposed.The performance of rN was then compared to that of LN ratio,log-odds of metastatic LNs(LODDs)and the 8th edition of the Union for International Cancer Control/American Joint Committee on Cancer(UICC/AJCC)N classification.Results:The optimal cut-off values for Group 1 and 2 were 13 and 9,respectively.The 5-year overall survival(OS)was higher for patients in retrieved Group 1 LNs>13(vs.Group 1 LNs≤13,63.2%vs.57.9%,P=0.005)and retrieved Group 2 LNs>9(vs.Group 2 LNs≤9,72.5%vs.60.7%,P=0.009).Patients staged as pN0-3b were sub classified using this Group 1 and 2 nodal analogy.The OS of pN0-N2 patients in retrieved Group 1 LNs>13 or Group 2 LNs>9 were superior to those in retrieved Group 1 LNs≤13 and Group 2 LNs≤9(All P13 and>9 LNs for Group 1 and Group 2,respectively,could represent an alternative lymph node retrieval approach in radical gastrectomy for more precise survival prognostication and minimizing staging migration,especially if>16 LNs is found to be difficult.

关键词： Gastric cancer American Joint Committee on Cancer Japanese Gastric Cancer Association lymph node Prognosis lymph node ratio Log odds of metastatic lymph nodes Stage Migration Akaike information criterion Bayesian information criterion

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Optimal treatment for Siewert type Ⅱ and Ⅲ adenocarcinoma of the esophagogastric junction: A retrospective cohort study with long-term follow-up

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World Journal of Gastroenterology 2017年第15期23卷 2723-2730页

作者： Kei Hosoda Keishi Yamashita Hiromitsu Moriya Hiroaki Mieno Masahiko Watanabe Department of Surgery Kitasato University School of Medicine

AIM To determine the optimal treatment strategy for Siewert type Ⅱ and?Ⅲ?adenocarcinoma of the esophagogastric junction.METHODS We retrospectively reviewed the medical records of 83 patients with Siewert type?Ⅱ?and?Ⅲ?adenocarcinoma of the esophagogastric junction and calculated both an index of estimated benefit from lymph node dissection for each lymph node(LN) station and a lymph node ratio(LNR: ratio of number of positive lymph nodes to the total number of dissected lymph nodes). We used Cox proportional hazard models to clarify independent poor prognostic factors. The median duration of observation was 73 mo.RESULTS Indices of estimated benefit from LN dissection were as follows, in descending order: lymph nodes(LN) along the lesser curvature, 26.5; right paracardial LN, 22.8; left paracardial LN, 11.6; LN along the left gastric artery, 10.6. The 5-year overall survival(OS) rate was 58%. Cox regression analysis revealed that vigorous venous invasion(v2, v3)(HR = 5.99; 95%CI: 1.71-24.90) and LNR of > 0.16(HR = 4.29, 95%CI: 1.79-10.89) were independent poor prognostic factors for OS.CONCLUSION LN along the lesser curvature, right and left paracardial LN, and LN along the left gastric artery should be dissected in patients with Siewert type?Ⅱ?or?Ⅲ?adenoca rcinoma of the esophagogastric junction. Patients with vigorous venous invasion and LNR of > 0.16 should be treated with aggressive adjuvant chemotherapy to improve survival outcomes.

关键词： Adenocarcinoma of the esophagogastric junction lymph node ratio Venous invasion lymph node dissection Prognostic factor

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