Does Neoadjuvant Chemotherapy Change the Role of Regional Lymphadenectomy in Pancreatic Cancer Survival?

Francis Igor Macedo, Omar Picado, Peter J. Hosein, Vikas Dudeja, Dido Franceschi, Jose Wilson Mesquita-Neto, Danny Yakoub, Nipun B. Merchant

Research output: Contribution to journalArticle

Abstract

The objective of this study was to evaluate the role of lymph node (LN) dissection and staging in outcomes of patients with pancreatic adenocarcinoma (PDAC) who underwent neoadjuvant chemotherapy (NAC). Methods National Cancer Database was queried for patients with stages I to III PDAC diagnosed between 2004 and 2014. Overall survival (OS) was derived from Kaplan-Meier methods, and Cox-regression model was used to evaluate associations between the number of LN examined, number of positive nodes, and LN ratio with OS. Results A total 35,599 patients were included, 3395 (9%) underwent NAC, 19,865 (56%) received adjuvant chemotherapy (AC), and 12,299 (35%) underwent surgery alone. Cox-regression showed superior OS in NAC compared with AC and surgery alone (26 vs 23 vs 14 months, P < 0.001). Minimum number of LN examined affecting OS was 8 LNs in NAC (23.8 vs 26.6 months, P = 0.029), and 12 LNs in AC group (22 vs 23.1 months, P = 0.028). Lymph node ratio cutoff of greater than 0.2 was associated with decreased OS (19.4 vs 24.4 months, P < 0.001). Conclusions Neoadjuvant chemotherapy is associated with improved survival in PDAC. Lymph node yield remains a significant prognostic factor after NAC, whereas the minimum number of harvested LNs associated with sufficient staging and survival is decreased.

Original languageEnglish (US)
Pages (from-to)823-831
Number of pages9
JournalPancreas
Volume48
Issue number6
DOIs
StatePublished - Jul 1 2019

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Lymph Node Excision
Pancreatic Neoplasms
Drug Therapy
Survival
Lymph Nodes
Adjuvant Chemotherapy
Proportional Hazards Models
Adenocarcinoma
Databases
Neoplasms

All Science Journal Classification (ASJC) codes

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Hepatology
  • Endocrinology

Cite this

Macedo, F. I., Picado, O., Hosein, P. J., Dudeja, V., Franceschi, D., Mesquita-Neto, J. W., ... Merchant, N. B. (2019). Does Neoadjuvant Chemotherapy Change the Role of Regional Lymphadenectomy in Pancreatic Cancer Survival? Pancreas, 48(6), 823-831. https://doi.org/10.1097/MPA.0000000000001339

Does Neoadjuvant Chemotherapy Change the Role of Regional Lymphadenectomy in Pancreatic Cancer Survival? / Macedo, Francis Igor; Picado, Omar; Hosein, Peter J.; Dudeja, Vikas; Franceschi, Dido; Mesquita-Neto, Jose Wilson; Yakoub, Danny; Merchant, Nipun B.

In: Pancreas, Vol. 48, No. 6, 01.07.2019, p. 823-831.

Research output: Contribution to journalArticle

Macedo, FI, Picado, O, Hosein, PJ, Dudeja, V, Franceschi, D, Mesquita-Neto, JW, Yakoub, D & Merchant, NB 2019, 'Does Neoadjuvant Chemotherapy Change the Role of Regional Lymphadenectomy in Pancreatic Cancer Survival?', Pancreas, vol. 48, no. 6, pp. 823-831. https://doi.org/10.1097/MPA.0000000000001339
Macedo FI, Picado O, Hosein PJ, Dudeja V, Franceschi D, Mesquita-Neto JW et al. Does Neoadjuvant Chemotherapy Change the Role of Regional Lymphadenectomy in Pancreatic Cancer Survival? Pancreas. 2019 Jul 1;48(6):823-831. https://doi.org/10.1097/MPA.0000000000001339
Macedo, Francis Igor ; Picado, Omar ; Hosein, Peter J. ; Dudeja, Vikas ; Franceschi, Dido ; Mesquita-Neto, Jose Wilson ; Yakoub, Danny ; Merchant, Nipun B. / Does Neoadjuvant Chemotherapy Change the Role of Regional Lymphadenectomy in Pancreatic Cancer Survival?. In: Pancreas. 2019 ; Vol. 48, No. 6. pp. 823-831.
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abstract = "The objective of this study was to evaluate the role of lymph node (LN) dissection and staging in outcomes of patients with pancreatic adenocarcinoma (PDAC) who underwent neoadjuvant chemotherapy (NAC). Methods National Cancer Database was queried for patients with stages I to III PDAC diagnosed between 2004 and 2014. Overall survival (OS) was derived from Kaplan-Meier methods, and Cox-regression model was used to evaluate associations between the number of LN examined, number of positive nodes, and LN ratio with OS. Results A total 35,599 patients were included, 3395 (9{\%}) underwent NAC, 19,865 (56{\%}) received adjuvant chemotherapy (AC), and 12,299 (35{\%}) underwent surgery alone. Cox-regression showed superior OS in NAC compared with AC and surgery alone (26 vs 23 vs 14 months, P < 0.001). Minimum number of LN examined affecting OS was 8 LNs in NAC (23.8 vs 26.6 months, P = 0.029), and 12 LNs in AC group (22 vs 23.1 months, P = 0.028). Lymph node ratio cutoff of greater than 0.2 was associated with decreased OS (19.4 vs 24.4 months, P < 0.001). Conclusions Neoadjuvant chemotherapy is associated with improved survival in PDAC. Lymph node yield remains a significant prognostic factor after NAC, whereas the minimum number of harvested LNs associated with sufficient staging and survival is decreased.",
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AU - Franceschi, Dido

AU - Mesquita-Neto, Jose Wilson

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AB - The objective of this study was to evaluate the role of lymph node (LN) dissection and staging in outcomes of patients with pancreatic adenocarcinoma (PDAC) who underwent neoadjuvant chemotherapy (NAC). Methods National Cancer Database was queried for patients with stages I to III PDAC diagnosed between 2004 and 2014. Overall survival (OS) was derived from Kaplan-Meier methods, and Cox-regression model was used to evaluate associations between the number of LN examined, number of positive nodes, and LN ratio with OS. Results A total 35,599 patients were included, 3395 (9%) underwent NAC, 19,865 (56%) received adjuvant chemotherapy (AC), and 12,299 (35%) underwent surgery alone. Cox-regression showed superior OS in NAC compared with AC and surgery alone (26 vs 23 vs 14 months, P < 0.001). Minimum number of LN examined affecting OS was 8 LNs in NAC (23.8 vs 26.6 months, P = 0.029), and 12 LNs in AC group (22 vs 23.1 months, P = 0.028). Lymph node ratio cutoff of greater than 0.2 was associated with decreased OS (19.4 vs 24.4 months, P < 0.001). Conclusions Neoadjuvant chemotherapy is associated with improved survival in PDAC. Lymph node yield remains a significant prognostic factor after NAC, whereas the minimum number of harvested LNs associated with sufficient staging and survival is decreased.

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