Abstract
In patients with cancer of the pancreatic head, metastasis to para-aortic lymph nodes (LN16) is considered distant metastasis and a poor prognostic marker. However, the incidence of LN16 involvement in pancreatic head cancer is high, and it is unclear whether all such patients have poor surgical outcomes. We investigated the significance of LN16 involvement in resectable pancreatic head cancer by retrospectively analyzing 579 ductal adenocarcinoma patients treated with para-aortic lymph node dissection at two high-volume Chinese centers. Depending upon tumor location, the incidence of LN16 metastasis and the correlation between LN16 involvement and involvement of Group 1 or 2 lymph nodes significantly differed. Metastasis to LN16 indicated a high serum tumor burden and a poor prognosis, though LN16-positive patients with a lymph node ratio (LNR) < 0.25 may still benefit from radical surgery. Survival analysis of LN16-positive patients with resectable pancreatic head cancer revealed that tumor size, tumor differentiation, and tumor location are independent prognostic factors. We also found that preoperative serum CA125 < 18.62 U/ml and the level of JAK2 signaling are both indicators of who may benefit from curative surgical resection for pancreatic head cancer.
Highlights
The incidence of pancreatic adenocarcinoma, which has an average five-year survival rate of about 6%, has increased in China over the past several decades [1]
We investigated the significance of LN16 involvement in resectable pancreatic head cancer by retrospectively analyzing 579 ductal adenocarcinoma patients treated with paraaortic lymph node dissection at two high-volume Chinese centers
There was a strong correlation between metastasis to LN16 and to lymph nodes Group 1 or 2 in the entire sample (p < 0.001), the significance unexpectedly disappeared when we examined dorsal pancreatic tumors as a unique subgroup (p = 0.075, Table 1, Figure 1)
Summary
The incidence of pancreatic adenocarcinoma, which has an average five-year survival rate of about 6%, has increased in China over the past several decades [1]. Among patients diagnosed with pancreatic cancer, less than 20% are eligible for a curative resection [2]. It is extremely important to conduct an optimal surgery and extensive lymphadenectomy during surgery for every resectable case of pancreatic cancer. The status of lymph node involvement is a critical prognostic factor for pancreatic ductal adenocarcinoma [3]. There is little agreement regarding what constitutes an optimal lymphadenectomy during pancreatic resection. Extended resection including partial Group 2 and Group 3 lymph node stations, such as LN 8p, 9, 12a, 12p, 14c, 14d, 15, and 16, should not be routinely performed, due to lack of evidence that the patients will benefit from this high-risk surgery [4, 5]
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