Abstract
BackgroundThe therapeutic effect of lymph node dissection for pancreas invasive intraductal papillary mucinous neoplasms (IPMN) remains unclear. The study investigated whether cancer-specific survival (CSS) and overall survival (OS) rates among invasive IPMN patients improve when more lymph nodes are harvested during surgery.Study DesignThe study cohort was retrieved from the Surveillance, Epidemiology, and End Results (SEER) database. The lymph node count was categorized into quartiles. The relationship between lymph node count and survival was analyzed using Kaplan–Meier curves and a Cox proportional-hazards model. The stage migration was assessed by Chi-square tests. Propensity score matching (PSM) was used to minimize confounding variables between groups.ResultsIn total, 1,080 patients with resected invasive IPMNs from 1992 to 2011 were included. Univariate and multivariate Cox models indicated that an increased lymph node count independently improves survival. The Kaplan-Meier and log-rank tests identified 16 nodes as an optimal cut-off value that yielded a significant survival benefit for all invasive IPMN patients. The stage migration effect existed in this cohort. After PSM, the 5-year CSS increased from 36% to 47%, and the median survival rate increased from 30 months to 40 months by increasing the lymph node count to over 16, alone. The 5-year OS rate also provided additional support for this result.ConclusionIncreased lymph node counts were associated with improved survival in invasive IPMN patients. One cut-off value of lymph node count was 16 for this improvement.
Highlights
Intraductal papillary mucinous neoplasms (IPMN) have been increasingly recognized as an intraductal mucin-producing pancreatic neoplasms with tall, columnar mucin-containing epithelium and a lack of ovarian stroma, according to the World Health Organization definition [1,2]
Univariate and multivariate Cox models indicated that an increased lymph node count independently improves survival
After Propensity Score Matching (PSM), the 5-year cancer-specific survival (CSS) increased from 36% to 47%, and the median survival rate increased from 30 months to 40 months by increasing the lymph node count to over 16, alone
Summary
Intraductal papillary mucinous neoplasms (IPMN) have been increasingly recognized as an intraductal mucin-producing pancreatic neoplasms with tall, columnar mucin-containing epithelium and a lack of ovarian stroma, according to the World Health Organization definition [1,2]. 5% of all pancreatic cancers are invasive. The three major IPMN types are the main duct-type, branch duct-type, and the mixed-type, based on their relationships with the main pancreatic duct [7]. The common main duct-type IPMN features include main pancreatic duct obstruction and dilatation [8]. 40%–80% of main duct-type IPMNs are invasive lesions [9,10,11,12]. Branch duct-type IPMNs reside in the branches of the pancreatic duct. The therapeutic effect of lymph node dissection for pancreas invasive intraductal papillary mucinous neoplasms (IPMN) remains unclear. The study investigated whether cancer-specific survival (CSS) and overall survival (OS) rates among invasive IPMN patients improve when more lymph nodes are harvested during surgery
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