The station 8 lymph node: Is there any prognostic value?

Abstract

Presenter: Terence Jackson MD | Methodist Richardson Medical Center Background: Sentinel lymph node mapping for pancreatic cancer and their prognostic value is not well studied. A sentinel lymph node must be easily accessible and must have a high negative predictive value. We sought to identify the value of station 8 lymph nodes as a sentinel node for pancreatic cancer and their value in therapeutic decision making. Methods: 153 patients who underwent the Whipple procedure over a 3-year period (2016-2018). In each of these procedures, we routinely sampled the station 8 and 12 lymph nodes in all these cases and sent them separately for pathology evaluation. Patient demographics, pathologic data and postoperative outcomes were then retrospectively evaluated. Incomplete datasets and Whipple procedures performed for indications other than pancreatic adenocarcinoma were excluded, and a data analysis was run on the 95 remaining patients. Results: 95 patients with pancreatic cancer were evaluated. 10.53% (10) of these patients had positive station 8 nodes. Compared to patients with negative station 8 node, patients with positive station 8 nodes were more likely to have perineural invasion (90% vs 74%) and lymphovascular invasion (70% vs 55%). Patients with positive station 8 nodes were also more likely to have a positive portal vein margin (70% vs 16%) and a positive pancreas margin (60% vs 7%). Median disease free survival in patients with positive station 8 nodes was 8 months compared to 9 months in those with negative station 8 nodes. The negative predictive value of a negative station 8 lymph node to predict nodal involvement was only 32%. Conclusion: Based on our data we have ascertained that a positive station 8 lymph node portends to a poor prognosis, particularly with higher perineural and lymphovascular invasion. It can act as a predictor for positive portal vein and pancreatic margin. The utility of a positive station 8 node in therapeutic decision making is yet to determined however given the high margin positivity in this group, it could be used as an indication for methods of margin accentuation. It did not, however, act as a sentinel lymph node with a low negative predictive value in predicting nodal involvement.