Which patients with para-aortic lymph node (LN16) metastasis will truly benefit from curative pancreaticoduodenectomy for pancreatic head cancer?
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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
Xianjun Yu, e-mail: [email protected]
Keywords: pancreatic cancer, para-aortic lymph node, lymphadenectomy, metastasis, prognosis
Received: December 01, 2015 Accepted: March 28, 2016 Published: April 11, 2016
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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