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Lymph node ratio as parameter of regional lymph node involvement in pancreatic cancer

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Abstract

Purpose

To determine which indicators, anatomical nodal metastasis (Japan Pancreas Society, JPS), number of positive lymph nodes (PLN), or lymph node ratio (LNR), is the best means of assessing lymph node involvement in pancreatic cancer.

Methods

This retrospective study analyzed 275 patients with pancreatic cancer treated at a single institution. Survival curves according to the JPS, PLN, or LNR were assessed by the Kaplan–Meier method. Prognostic value of each classification was explored by Cox regression analysis after adjustments for clinical factors.

Results

Multivariate analysis showed that, relative to n0 in the JPS, hazard ratios (HR) in n1, n2, and n3 were 1.72, 1.73, and 2.75, respectively, with no difference in survival between n1 and n2. Relative to PLN of 0, the HR in the PLN categories of 1∼2, 3, and >3 were 1.39, 1.65, and 3.03, respectively. Relative to LNR of 0, the HR in the categories of 0 < LNR ≤ 0.1, 0.1 < LNR ≤ 0.2, and LNR > 0.2 were 1.27, 2.00, and 5.58, respectively. An incremental increase in the HR was observed as the LNR category progressed, and differences between the survivals were distinct when stratified by the LNR.

Conclusions

The LNR was an accurate predictor of survival among three assessment strategies and could be proposed as a candidate for use as N categories, pending validation studies.

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Authors’ contributions

• Study conception and design: Yamada S., Hirakawa A.

• Acquisition of data: Fujii T., Kanda M., Sugimoto H.

• Analysis and interpretation of data: Yamada S., Hirakawa A.

• Drafting of manuscript: Yamada S., Kodera Y.

• Critical revision of manuscript: Fujii T.

Author information

Authors and Affiliations

  1. Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan

    Suguru Yamada, Tsutomu Fujii, Mitsuro Kanda, Hiroyuki Sugimoto & Yasuhiro Kodera

  2. Biostatistics Section, Center for Advanced Medicine and Clinical Research, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan

    Akihiro Hirakawa

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  1. Suguru Yamada
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  2. Tsutomu Fujii
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  4. Mitsuro Kanda
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Correspondence to Suguru Yamada.

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Research involving human participants and/or animals

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Yamada, S., Fujii, T., Hirakawa, A. et al. Lymph node ratio as parameter of regional lymph node involvement in pancreatic cancer. Langenbecks Arch Surg 401, 1143–1152 (2016). https://doi.org/10.1007/s00423-016-1412-5

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  • DOI: https://doi.org/10.1007/s00423-016-1412-5

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