Oncotarget

Research Papers:

Which patients with para-aortic lymph node (LN16) metastasis will truly benefit from curative pancreaticoduodenectomy for pancreatic head cancer?

Chen Liu, Yu Lu, Guopei Luo, He Cheng, Meng Guo, Zuqiang Liu, Jin Xu, Jiang Long, Liang Liu, Deliang Fu, Quanxing Ni, Min Li and Xianjun Yu _

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Oncotarget. 2016; 7:29177-29186. https://doi.org/10.18632/oncotarget.8690

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Abstract

Chen Liu1,2,3,*, Yu Lu1,2,3,*, Guopei Luo1,2,3,*, He Cheng1,2,3, Meng Guo1,2,3, Zuqiang Liu1,2,3, Jin Xu1,2,3, Jiang Long1,2,3, Liang Liu1,2,3, Deliang Fu4, Quanxing Ni1,2,3, Min Li5, Xianjun Yu1,2,3

1Department of Pancreatic and Hepatobiliary Surgery, Fudan University Shanghai Cancer Center, Shanghai, P.R. China

2Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, P.R. China

3Pancreatic Cancer Institute, Fudan University, Shanghai, P.R. China

4Department of Pancreatic Surgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, P.R. China

5Department of Medicine, Department of Surgery, The University of Oklahoma Health Sciences Center, Stanton L. Young Biomedical Research Center, Oklahoma City, USA

*These authors contributed equally to this work

Correspondence to:

Xianjun Yu, e-mail: yuxianjun@fudanpci.org

Keywords: pancreatic cancer, para-aortic lymph node, lymphadenectomy, metastasis, prognosis

Received: December 01, 2015     Accepted: March 28, 2016     Published: April 11, 2016

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.


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