Impact of lymph node 8a and poor prognosis in pancreatic cancer

Abstract

Presenter: Danny Conde Monroy MD, MSc | Hospital Universitario Mayor Mederi/Universidad del Rosario Background: Pancreatic cancer occupies the 7th place worldwide in cancer related deaths. Now days, Surgical management followed by adjuvant therapy are the gold standard to treat it. However, average 5 years survival is 12-18%. It seems hepatic artery lymph (HLN) node metastasis (known as lymph node 8A) has significant negative impact on disease free survival time (DFS) and overall survival time (OS). In this study, we analyze the impact of HLN (Lymph Node 8A) metastases in overall and disease-free survival time on Pancreatic cancer in a cohort of patients. The principal objective is to evaluate the prognostic significance of HLA (Lymph node 8A) node metastasis in overall and disease-free survival time on Pancreatic cancer patients after pancreaticoduodenectomy (PD) in a both referral and high volume centre in Bogota, Colombia Methods: A retrospective observational cohort study of a prospective database was conducted. Patients incuded were those who underwent a pancreaticoduodenectomy for malignancy between 2014 – 2019 in a single institution by a single HPB surgeon in Bogotá, Colombia. Overall survival and disease-free survival time were estimated by Kaplan Meier analysis. Log-rank test and multivariate cox proportional hazards regression were used. Results: A total of 102 patients underwent PD resection between 2014 and 2019. 84 patients met inclusion criteria. Mean age was 63,11 years old. The total patients underwent standard NPPD (100%). 21.43% of the patients showed metastatic disease in HLN. Mean number of harvested lymph nodes was 14.84 (SD 5,8). Ductal adenocarcinoma was reported in 63,10 %. Ampullary carcinoma was 21.43%, and 5.95% for cholangiocarcinoma. Mean lymph node ratio was 0,45 (SD 0.05). OS in the positive HLN group was 12.5 months versus 23.16 in the negative group. (CI 95% 12-22). DFS in HLN + group was 13 months whereas the negative group was 20 months. (CI 95% 26; 22). Survival analysis for positive HLN node and lymph node ratio (LNR) > 0.6 show a strong relationship with OS (Cox Regression p 0.03 and 0.003 respectively CI 95%). In terms of DFS, only the LNR shows relationship with the outcome, with a significant statistical value (p 0.008 CI 95%). Conclusion: In our series of pancreaticoduodenectomy of Pancreatic Cancer, HLA (Lymph Node 8A) metastases were a significant factor related to poor prognosis. Therefore, it might be considered as an important prognostic factor in patients with pancreatic malignancy due to its statistical and clinical impact on overall survival and DFS. Further studies need to be done in order to confirm results of this study.