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Journal of Gastroenterology
Published in: Journal of Gastroenterology 6/2015

01-06-2015 | Original Article—Liver, Pancreas, and Biliary Tract

Postoperative prognosis of pancreatic cancer with para-aortic lymph node metastasis: a multicenter study on 822 patients

Authors: Masayuki Sho, Yoshiaki Murakami, Fuyuhiko Motoi, Sohei Satoi, Ippei Matsumoto, Manabu Kawai, Goro Honda, Kenichiro Uemura, Hiroaki Yanagimoto, Masanao Kurata, Takumi Fukumoto, Takahiro Akahori, Shoichi Kinoshita, Minako Nagai, Satoshi Nishiwada, Michiaki Unno, Hiroki Yamaue, Yoshiyuki Nakajima

Published in: Journal of Gastroenterology | Issue 6/2015

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Abstract

Background

The prognosis of pancreatic cancer patients with metastatic para-aortic lymph node (PALN) has been reported to be extremely poor. In general, PALN metastasis has been considered as a contraindication for pancreatic resection. The aim of this study was to reevaluate the postoperative prognostic value of PALN metastasis in pancreatic cancer and to determine the validity of pancreatic surgery.

Methods

Retrospective multicenter analysis of 882 patients who have undergone curative-intent pancreatic resection with pathological evaluation of PALNs for pancreatic ductal adenocarcinoma between 2001 and 2012 was conducted. Clinicopathological data and outcomes were evaluated with univariate and multivariate analysis.

Results

In total, 102 (12.4 %) patients had positive metastasis in PALN. Patients with metastatic PALN had significantly poorer survival than those without (17 vs. 23 months; p < 0.001). Multivariable analysis of 822 patients identified adjuvant chemotherapy, primary tumor status, regional lymph node metastasis, portal vein invasion, pre- and post-operative serum CA19-9 levels, and tumor grade as independent prognostic factors. In contrast, PALN metastasis did not have a significant prognostic value. Furthermore, the multivariate prognostic analysis in patients with PALN metastasis revealed that adjuvant chemotherapy and the number of metastatic PALN were significantly associated with long-term survival. Lung metastasis as initial recurrence was observed more often in patients with PALN metastasis in comparison with those without.

Conclusions

Some pancreatic cancer patients with metastatic PALN may survive for longer than expected after pancreatectomy. Adjuvant chemotherapy and the number of metastatic PALN were critical factors for long-term survival of those patients.
Literature
1.
Ma J, Siegel R, Jemal A. Pancreatic cancer death rates by race among US men and women, 1970–2009. J Natl Cancer Inst. 2013;105:1694–700.PubMedCrossRef
2.
Egawa S, Toma H, Ohigashi H, Okusaka T, Nakao A, Hatori T, et al. Japan Pancreatic Cancer Registry; 30th year anniversary: Japan Pancreas Society. Pancreas. 2012;41:985–92.PubMedCrossRef
3.
Ueno H, Ioka T, Ikeda M, Ohkawa S, Yanagimoto H, Boku N, et al. Randomized phase III study of gemcitabine plus S-1, S-1 alone, or gemcitabine alone in patients with locally advanced and metastatic pancreatic cancer in Japan and Taiwan: GEST study. J Clin Oncol. 2013;31:1640–8.PubMedCrossRef
4.
Moore MJ, Goldstein D, Hamm J, Figer A, Hecht JR, Gallinger S, et al. Erlotinib plus gemcitabine compared with gemcitabine alone in patients with advanced pancreatic cancer: a phase III trial of the National Cancer Institute of Canada Clinical Trials Group. J Clin Oncol. 2007;25:1960–6.PubMedCrossRef
5.
Paulson AS, Tran Cao HS, Tempero MA, Lowy AM. Therapeutic advances in pancreatic cancer. Gastroenterology. 2013;144:1316–26.PubMedCrossRef
6.
Konstantinidis IT, Warshaw AL, Allen JN, Blaszkowsky LS, Castillo CF, Deshpande V, et al. Pancreatic ductal adenocarcinoma: is there a survival difference for R1 resections versus locally advanced unresectable tumors? What is a “true” R0 resection? Ann Surg. 2013;257:731–6.PubMedCrossRef
7.
Schnelldorfer T, Ware AL, Sarr MG, Smyrk TC, Zhang L, Qin R, et al. Long-term survival after pancreatoduodenectomy for pancreatic adenocarcinoma: is cure possible? Ann Surg. 2008;247:456–62.PubMedCrossRef
8.
Tamm EP, Balachandran A, Bhosale PR, Katz MH, Fleming JB, Lee JH, et al. Imaging of pancreatic adenocarcinoma: update on staging/resectability. Radiol Clin North Am. 2012;50:407–28.PubMedCrossRef
9.
Edge SB, Compton CC. The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol. 2010;17:1471–4.PubMedCrossRef
10.
Sobin LH, Gospodarowicz MK, Wittekind C. TNM classification of malignant tumors. 7th ed. New York: Wiley; 2010.
11.
Shimada K, Sakamoto Y, Sano T, Kosuge T. The role of paraaortic lymph node involvement on early recurrence and survival after macroscopic curative resection with extended lymphadenectomy for pancreatic carcinoma. J Am Coll Surg. 2006;203:345–52.PubMedCrossRef
12.
Murakami Y, Uemura K, Sudo T, Hashimoto Y, Yuasa Y, Sueda T. Prognostic impact of para-aortic lymph node metastasis in pancreatic ductal adenocarcinoma. World J Surg. 2010;34:1900–7.PubMedCrossRef
13.
Doi R, Kami K, Ito D, Fujimoto K, Kawaguchi Y, Wada M, et al. Prognostic implication of para-aortic lymph node metastasis in resectable pancreatic cancer. World J Surg. 2007;31:147–54.PubMedCrossRef
14.
Kanda M, Fujii T, Nagai S, Kodera Y, Kanzaki A, Sahin TT, et al. Pattern of lymph node metastasis spread in pancreatic cancer. Pancreas. 2011;40:951–5.PubMedCrossRef
15.
Sakai M, Nakao A, Kaneko T, Takeda S, Inoue S, Kodera Y, et al. Para-aortic lymph node metastasis in carcinoma of the head of the pancreas. Surgery. 2005;137:606–11.PubMedCrossRef
16.
Schwarz L, Lupinacci RM, Svrcek M, Lesurtel M, Bubenheim M, Vuarnesson H, et al. Para-aortic lymph node sampling in pancreatic head adenocarcinoma. Br J Surg. 2014;101:530–8.PubMedCrossRef
17.
Satoi S, Yamaue H, Kato K, Takahashi S, Hirono S, Takeda S, et al. Role of adjuvant surgery for patients with initially unresectable pancreatic cancer with a long-term favorable response to non-surgical anti-cancer treatments: results of a project study for pancreatic surgery by the Japanese Society of Hepato-Biliary-Pancreatic Surgery. J Hepatobiliary Pancreat Sci. 2013;20(6):590–600.PubMedCrossRef
18.
Aristu J, Canon R, Pardo F, Martinez-Monge R, Martin-Algarra S, Manuel Ordonez J, et al. Surgical resection after preoperative chemoradiotherapy benefits selected patients with unresectable pancreatic cancer. Am J Clin Oncol. 2003;26:30–6.PubMedCrossRef
19.
Bickenbach KA, Gonen M, Tang LH, O’Reilly E, Goodman K, Brennan MF, et al. Downstaging in pancreatic cancer: a matched analysis of patients resected following systemic treatment of initially locally unresectable disease. Ann Surg Oncol. 2012;19:1663–9.PubMedCrossRef
20.
Masui T, Kubota T, Aoki K, Nakanishi Y, Miyamoto T, Nagata J, et al. Long-term survival after resection of pancreatic ductal adenocarcinoma with para-aortic lymph node metastasis: case report. World J Surg Oncol. 2013;11:195.PubMedCentralPubMedCrossRef
21.
Japan Pancreas Society. Classification of pancreatic carcinoma (2nd English edition). Japan Pancreas Society e: Kanehara & Co.; 2003.
22.
Conroy T, Desseigne F, Ychou M, Bouche O, Guimbaud R, Becouarn Y, et al. FOLFIRINOX versus gemcitabine for metastatic pancreatic cancer. N Engl J Med. 2011;364:1817–25.PubMedCrossRef
23.
Von Hoff DD, Ervin T, Arena FP, Chiorean EG, Infante J, Moore M, et al. Increased survival in pancreatic cancer with nab-paclitaxel plus gemcitabine. N Engl J Med. 2013;369:1691–703.CrossRef
24.
Oettle H, Post S, Neuhaus P, Gellert K, Langrehr J, Ridwelski K, et al. Adjuvant chemotherapy with gemcitabine vs observation in patients undergoing curative-intent resection of pancreatic cancer: a randomized controlled trial. JAMA. 2007;297:267–77.PubMedCrossRef
25.
Ueno H, Kosuge T, Matsuyama Y, Yamamoto J, Nakao A, Egawa S, et al. A randomised phase III trial comparing gemcitabine with surgery-only in patients with resected pancreatic cancer: Japanese Study Group of Adjuvant Therapy for Pancreatic Cancer. Br J Cancer. 2009;101:908–15.PubMedCentralPubMedCrossRef
26.
Sho M, Tanaka T, Yamada T, Nomi T, Akahori T, Doh J, et al. Novel postoperative adjuvant strategy prevents early hepatic recurrence after resection of pancreatic cancer. J Hepatobiliary Pancreat Sci. 2011;18:235–9 (discussion 9–40).PubMedCrossRef
27.
Murakami Y, Uemura K, Sudo T, Hashimoto Y, Nakashima A, Kondo N, et al. Long-term results of adjuvant gemcitabine plus S-1 chemotherapy after surgical resection for pancreatic carcinoma. J Surg Oncol. 2012;106:174–80.PubMedCrossRef
28.
Imai H, Doi R, Kanazawa H, Kamo N, Koizumi M, Masui T, et al. Preoperative assessment of para-aortic lymph node metastasis in patients with pancreatic cancer. Int J Clin Oncol. 2010;15:294–300.PubMedCrossRef
29.
Matsumoto I, Shirakawa S, Shinzeki M, Asari S, Goto T, Ajiki T, et al. 18-Fluorodeoxyglucose positron emission tomography does not aid in diagnosis of pancreatic ductal adenocarcinoma. Clin Gastroenterol Hepatol. 2013;11:712–8.PubMedCrossRef
30.
Yamada S, Nakao A, Fujii T, Sugimoto H, Kanazumi N, Nomoto S, et al. Pancreatic cancer with paraaortic lymph node metastasis: a contraindication for radical surgery? Pancreas. 2009;38:e13–7.PubMedCrossRef
31.
32.
Hirono S, Tani M, Kawai M, Okada K, Miyazawa M, Shimizu A, et al. Identification of the lymphatic drainage pathways from the pancreatic head guided by indocyanine green fluorescence imaging during pancreaticoduodenectomy. Dig Surg. 2012;29:132–9.PubMedCrossRef
Metadata
Title
Postoperative prognosis of pancreatic cancer with para-aortic lymph node metastasis: a multicenter study on 822 patients
Authors
Masayuki Sho
Yoshiaki Murakami
Fuyuhiko Motoi
Sohei Satoi
Ippei Matsumoto
Manabu Kawai
Goro Honda
Kenichiro Uemura
Hiroaki Yanagimoto
Masanao Kurata
Takumi Fukumoto
Takahiro Akahori
Shoichi Kinoshita
Minako Nagai
Satoshi Nishiwada
Michiaki Unno
Hiroki Yamaue
Yoshiyuki Nakajima
Publication date
01-06-2015
Publisher
Springer Japan
Published in
Journal of Gastroenterology / Issue 6/2015
Print ISSN: 0944-1174
Electronic ISSN: 1435-5922
DOI
https://doi.org/10.1007/s00535-014-1005-4

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