Clinical Research Papers:

Lymph node ratio, but not the total number of examined lymph nodes or lymph node metastasis, is a predictor of overall survival for pancreatic neuroendocrine neoplasms after surgical resection

Peng Liu, Xianbin Zhang _, Yuru Shang, Lili Lu, Fei Cao, Min Sun, Zhaohui Tang, Brigitte Vollmar and Peng Gong

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Oncotarget. 2017; 8:89245-89255. https://doi.org/10.18632/oncotarget.19184

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Peng Liu1,*, Xianbin Zhang1,2,*, Yuru Shang1, Lili Lu3, Fei Cao1, Min Sun4, Zhaohui Tang5, Brigitte Vollmar2 and Peng Gong1,6

1Department of Hepatobiliary Surgery, The First Affiliated Hospital of Dalian Medical University, Dalian, 116011, China

2Institute of Experimental Surgery, University of Rostock, Schillingallee 69a, Rostock, 18059, Germany

3Department of Epidemiology, Dalian Medical University, Dalian, 116044, China

4Department of Oncology, Zhongnan Hospital of Wuhan University, Hubei Key Laboratory of Tumor Biological Behaviors and Hubei Cancer Clinical Study Center, Wuhan, 430071, China

5Department of General Surgery, Xinhua Hospital Shanghai Jiaotong University, Shanghai, 200092, China

6Dalian Key Laboratory of Hepatobiliary Pancreatic Diseases Prevention and Treatment and Liaoning Key Laboratory of Molecular Targeted Drugs in Hepatobiliary and Pancreatic Cancer, Dalian, 116011, China

*These authors contributed equally to this work

Correspondence to:

Xianbin Zhang, email: [email protected]

Peng Gong, email: [email protected]

Keywords: pancreatic neuroendocrine neoplasms, lymph node ratio, examined lymph nodes, lymph node metastasis, overall survival

Received: January 18, 2017     Accepted: June 28, 2017     Published: July 12, 2017


Aim: To evaluate the prognostic significance of lymph node metastasis, extent of examined lymph nodes (ELNs) and lymph node ratio (LNR) for resected pancreatic neuroendocrine neoplasms (pNENs).

Materials and Methods: Surgically resected pNENs were assimilated from the Surveillance, Epidemiology, and End Results database. Kaplan-Meier and Cox proportional hazard models were used to examine the prognostic effect of clinicopathological characteristics on overall survival; Harrell’s concordance index was performed to assess the prognostic accuracy of all independent prognostic factors; and the Spearman’s rank correlation was used to assess the correlation between LNR and other clinicopathological characteristics.

Results: Totally, 1,273 pathologically confirmed pNENs were included in our study. The extent of ELNs failed to show any survival benefit in entire cohort (ELNs ≤ 12 vs. ELNs > 12, P = 0.072) or pNENs without lymph node metastasis (ELNs ≤ 28 vs. ELNs > 28, P = 0.108). Lymph node metastasis and LNR > 0.40 were significantly (both P < 0.001) adverse prognostic factors of overall survival. However, only LNR > 0.40 was the independent predictor of survival after adjusted for other clinicopathological characteristics. Besides LNR, the age, gender, primary tumor site, grade and stage also were the independent predictors of overall survival; and this survival model had an acceptable predictive power (Harrell’s concordance index, 0.731).

Conclusions: The current study suggested that the LNR, not the total number of ELNs and the lymph node metastasis, is an independent prognostic indicator of overall survival for pNENs after surgical resection.

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