Journal
INTERNATIONAL JOURNAL OF SURGICAL PATHOLOGY
Volume 26, Issue 8, Pages 707-713Publisher
SAGE PUBLICATIONS INC
DOI: 10.1177/1066896918780343
Keywords
pancreas cancer; survival; lymph nodes; lymph node ratio; pancreatoduodenectomy
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Background. Lymph node metastasis (LNM) is a strong prognostic factor in the cancer of the pancreatobiliary tree, but it is influenced by the number of lymph nodes (LNs). The lymph node ratio (LNR) is considered a more reliable factor than the number of LNM. The aim was to examine the LN retrieval and the LNR of 3 pathologic work-up strategies. Methods. Pancreaticoduodenectomies (n = 165) were analyzed comparing 3 pathological dissection techniques, classified as control, Verbeke method, and Adsay method groups. Results. The mean of the dissected LNs and the number of cases with >20 LNs were superior in the Adsay method group, compared with the other groups (P < .001). The LNR was different between the Adsay and Verbeke groups (0.144 vs 0.069, P = .032). The median of the 3 positive LNs was associated with decreased survival compared with an absence of LNM (3-year specific survival of 48% vs 22%, P = .011). In the multivariate analysis, LNM (hazard ratio = 6.148, 95% confidence interval = 2.02-8.1, P = .042) and the evaluation of >15 LNs (hazard ratio = 12.52, 95% confidence interval = 5.51-21.01, P = .001) were independent predictors of survival. Conclusion. The Adsay technique for LN retrieval was associated with a better LN count, more cases with LNM, and an LNR >0.1.
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