Substaging of lymph node status in resected pancreatic ductal adenocarcinoma has strong prognostic correlations: Proposal for a revised N classification for TNM staging

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dc.authorid0000-0001-6830-7701
dc.contributor.authorBaştürk, Olca
dc.contributor.authorSaka, Burcu
dc.contributor.authorBalcı, Serdar
dc.contributor.authorPostlewait, Lauren Mc Lendon
dc.contributor.authorKnight, Jessica
dc.contributor.authorGoodman, Michael
dc.contributor.authorKooby, David
dc.contributor.authorSarmiento J.M.
dc.contributor.authorEl-Rayes, Bassel
dc.contributor.authorChoi, Hyejeong
dc.contributor.authorBağcı, Pelin
dc.contributor.authorKrasinskas, Alyssa
dc.contributor.authorQuigley, Brian Christopher
dc.contributor.authorReid, Michelle Dian
dc.contributor.authorAkkaş, Gizem
dc.contributor.authorMaithel, Shishir Kumar
dc.contributor.authorAdsay, Nazmi Volkan
dc.date.accessioned10.07.201910:49:13
dc.date.accessioned2019-07-10T19:35:47Z
dc.date.available10.07.201910:49:14
dc.date.available2019-07-10T19:35:47Z
dc.date.issued2015
dc.departmentİstanbul Medipol Üniversitesi, Tıp Fakültesi, Cerrahi Tıp Bilimleri Bölümü, Tıbbi Patoloji Ana Bilim Dalı
dc.description.abstractBackground: The current tumor-node-metastasis staging system for the pancreas does not incorporate the number of lymph nodes (LNs) with metastasis. Methods: Among 1649 pancreaticoduodenectomies, 227 stringently defined pancreatic ductal adenocarcinomas (PDACs) that had undergone a specific approach of LN harvesting were analyzed for the prognostic value of LN substaging protocols used for other gastrointestinal (GI) organs. Results: The median number of LNs harvested was 18, and the median number of LNs with metastasis was 3. Lymph node metastasis was detected in 175 cases (77 %). The number of LNs involved correlated significantly with clinical outcome. When cases were substaged with the protocol already in use for the upper GI organs (N0: no metastasis, N1: metastasis to 1–2 LNs; N2: metastasis to ?3 LNs), the median overall survival times were 35, 21, and 18 months, and the respective 3-year survival rates were 46, 34, and 20 % (p = 0.004). Analysis of the Surveillance, Epidemiology and End Results (SEER) database also confirmed the survival differences between these substages (median overall survival times of 23, 15, and 14 months and respective 3-year survival rates of 37, 22, and 18 %; p < 0.0001). The substaging protocol for the lower GI organs (N0: no metastasis; N1: metastasis to 1–3 LNs; N2: metastasis to ?4 LNs) also was significant, with median overall survival times of 35, 21, 18 months and respective 3-year survival rates of 46, 26, and 23 %; p = 0.009). The association between higher N stage and shorter survival persisted with multivariate modeling for both protocols, although the prognostic value of the upper GI protocol appeared to be slightly stronger according to the Akaike Information Criterion method. Conclusion: In conclusion, with proper LN harvesting, the LN metastasis rate in PDACs is very high (77 %). Substaging of LN metastasis has significant prognostic value and needs to be considered in the N staging of PDACs. The protocol already in use for other upper GI tract organs, which currently also is proven significant for ampulla, would be preferable, although the lower GI tract protocol also is applicable.
dc.description.sponsorshipUnited States Department of Health & Human Services National Institutes of Health (NIH) - USAen_US
dc.description.sponsorshipKatz Foundationen_US
dc.identifier.citationBaştürk, O., Saka, B., Balcı, S., Postlewait, L. M. L., Knight, J., Goodman, M. ... Adsay, N. V. (2015). Substaging of lymph node status in resected pancreatic ductal adenocarcinoma has strong prognostic correlations: Proposal for a revised N classification for TNM staging. Annals of Surgical Oncology, 22(Supplement: 3), 1187-1195. https://dx.doi.org/10.1245/s10434-015-4861-0
dc.identifier.doi10.1245/s10434-015-4861-0
dc.identifier.endpage1195
dc.identifier.issn1068-9265
dc.identifier.issueSupplement: 3
dc.identifier.scopusqualityQ1
dc.identifier.startpage1187
dc.identifier.urihttps://hdl.handle.net/20.500.12511/942
dc.identifier.urihttps://dx.doi.org/10.1245/s10434-015-4861-0
dc.identifier.volume22
dc.identifier.wosqualityQ1
dc.indekslendigikaynakWeb of Science
dc.indekslendigikaynakScopus
dc.indekslendigikaynakPubMed
dc.language.isoen
dc.publisherSpringer
dc.relation.ispartofAnnals of Surgical Oncologyen_US
dc.relation.publicationcategoryMakale - Uluslararası Hakemli Dergi - Kurum Öğretim Elemanı
dc.rightsinfo:eu-repo/semantics/openAccess
dc.subjectTumor-Node-Metastasis
dc.subjectTNM Staging
dc.subjectSubstaging
dc.titleSubstaging of lymph node status in resected pancreatic ductal adenocarcinoma has strong prognostic correlations: Proposal for a revised N classification for TNM staging
dc.typeArticle

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