The role of hepatic artery lymph node in pancreatic adenocarcinoma: Prognostic factor or a selection criterion for surgery

Prejesh Philips, Erik Dunki-Jacobs, Steven Agle, Charles Scoggins, Kelly M. McMasters, Robert C G Martin

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background Hepatic artery lymph node (HALN) metastasis in pancreatic adenocarcinoma reportedly confers a survival disadvantage. This has led some authors to propose it as an indicator against pancreaticoduodenectomy (PD).

Methods Consecutive patients who underwent PD during 2002-2012 were identified from the University of Louisville prospective hepatopancreaticobiliary database. Overall survival (OS) and disease-free survival (DFS) were estimated using Kaplan-Meier analysis. The log-rank test and multivariate Cox proportional hazards regression were used in further analyses.

Results A total of 420 patients underwent PD during the period of study, of whom 197 had lymph node (LN) metastasis. Among these, 41 (20.8%) patients had disease-positive HALNs. The HALN was the only site of LN metastasis in only three of the 247 patients (1.2%). Median follow-up was 18.5 months (interquartile range: 4.1-28.2 months). Median OS and DFS were 22.7 months [95% confidence interval (CI) 19.0-26.3] and 12.6 months (95% CI 10.2-15.2). There was no significant difference in median OS between HALN-positive patients (18.4 months, 95% CI 12.3-24.0) and HALN-negative patients (19.7 months, 95% CI 16.7-22.6) (P = 0.659). On multivariate analysis, the hazard ratio (HR) of death was highest among patients with an LN ratio of >0.2 (HR 1.2, 95% CI 1.1-1.29; P = 0.012) followed by those with poorly differentiated histology (HR 1.09, 95% CI 1.04-1.11; P = 0.029).

Conclusions In pancreatic adenocarcinoma patients with LN disease, survival after PD is comparable regardless of HALN status. Therefore, HALN-positive disease should not preclude the performance of PD.

Original languageEnglish (US)
Pages (from-to)1051-1055
Number of pages5
JournalHPB
Volume16
Issue number12
DOIs
StatePublished - Dec 1 2014
Externally publishedYes

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Hepatic Artery
Patient Selection
Adenocarcinoma
Lymph Nodes
Pancreaticoduodenectomy
Confidence Intervals
Survival
Neoplasm Metastasis
Disease-Free Survival
Kaplan-Meier Estimate
Histology
Multivariate Analysis
Databases

ASJC Scopus subject areas

  • Gastroenterology
  • Hepatology
  • Medicine(all)

Cite this

Philips, P., Dunki-Jacobs, E., Agle, S., Scoggins, C., McMasters, K. M., & Martin, R. C. G. (2014). The role of hepatic artery lymph node in pancreatic adenocarcinoma: Prognostic factor or a selection criterion for surgery. HPB, 16(12), 1051-1055. https://doi.org/10.1111/hpb.12306

The role of hepatic artery lymph node in pancreatic adenocarcinoma : Prognostic factor or a selection criterion for surgery. / Philips, Prejesh; Dunki-Jacobs, Erik; Agle, Steven; Scoggins, Charles; McMasters, Kelly M.; Martin, Robert C G.

In: HPB, Vol. 16, No. 12, 01.12.2014, p. 1051-1055.

Research output: Contribution to journalArticle

Philips, P, Dunki-Jacobs, E, Agle, S, Scoggins, C, McMasters, KM & Martin, RCG 2014, 'The role of hepatic artery lymph node in pancreatic adenocarcinoma: Prognostic factor or a selection criterion for surgery', HPB, vol. 16, no. 12, pp. 1051-1055. https://doi.org/10.1111/hpb.12306
Philips P, Dunki-Jacobs E, Agle S, Scoggins C, McMasters KM, Martin RCG. The role of hepatic artery lymph node in pancreatic adenocarcinoma: Prognostic factor or a selection criterion for surgery. HPB. 2014 Dec 1;16(12):1051-1055. https://doi.org/10.1111/hpb.12306
Philips, Prejesh ; Dunki-Jacobs, Erik ; Agle, Steven ; Scoggins, Charles ; McMasters, Kelly M. ; Martin, Robert C G. / The role of hepatic artery lymph node in pancreatic adenocarcinoma : Prognostic factor or a selection criterion for surgery. In: HPB. 2014 ; Vol. 16, No. 12. pp. 1051-1055.
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abstract = "Background Hepatic artery lymph node (HALN) metastasis in pancreatic adenocarcinoma reportedly confers a survival disadvantage. This has led some authors to propose it as an indicator against pancreaticoduodenectomy (PD).Methods Consecutive patients who underwent PD during 2002-2012 were identified from the University of Louisville prospective hepatopancreaticobiliary database. Overall survival (OS) and disease-free survival (DFS) were estimated using Kaplan-Meier analysis. The log-rank test and multivariate Cox proportional hazards regression were used in further analyses.Results A total of 420 patients underwent PD during the period of study, of whom 197 had lymph node (LN) metastasis. Among these, 41 (20.8{\%}) patients had disease-positive HALNs. The HALN was the only site of LN metastasis in only three of the 247 patients (1.2{\%}). Median follow-up was 18.5 months (interquartile range: 4.1-28.2 months). Median OS and DFS were 22.7 months [95{\%} confidence interval (CI) 19.0-26.3] and 12.6 months (95{\%} CI 10.2-15.2). There was no significant difference in median OS between HALN-positive patients (18.4 months, 95{\%} CI 12.3-24.0) and HALN-negative patients (19.7 months, 95{\%} CI 16.7-22.6) (P = 0.659). On multivariate analysis, the hazard ratio (HR) of death was highest among patients with an LN ratio of >0.2 (HR 1.2, 95{\%} CI 1.1-1.29; P = 0.012) followed by those with poorly differentiated histology (HR 1.09, 95{\%} CI 1.04-1.11; P = 0.029).Conclusions In pancreatic adenocarcinoma patients with LN disease, survival after PD is comparable regardless of HALN status. Therefore, HALN-positive disease should not preclude the performance of PD.",
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N2 - Background Hepatic artery lymph node (HALN) metastasis in pancreatic adenocarcinoma reportedly confers a survival disadvantage. This has led some authors to propose it as an indicator against pancreaticoduodenectomy (PD).Methods Consecutive patients who underwent PD during 2002-2012 were identified from the University of Louisville prospective hepatopancreaticobiliary database. Overall survival (OS) and disease-free survival (DFS) were estimated using Kaplan-Meier analysis. The log-rank test and multivariate Cox proportional hazards regression were used in further analyses.Results A total of 420 patients underwent PD during the period of study, of whom 197 had lymph node (LN) metastasis. Among these, 41 (20.8%) patients had disease-positive HALNs. The HALN was the only site of LN metastasis in only three of the 247 patients (1.2%). Median follow-up was 18.5 months (interquartile range: 4.1-28.2 months). Median OS and DFS were 22.7 months [95% confidence interval (CI) 19.0-26.3] and 12.6 months (95% CI 10.2-15.2). There was no significant difference in median OS between HALN-positive patients (18.4 months, 95% CI 12.3-24.0) and HALN-negative patients (19.7 months, 95% CI 16.7-22.6) (P = 0.659). On multivariate analysis, the hazard ratio (HR) of death was highest among patients with an LN ratio of >0.2 (HR 1.2, 95% CI 1.1-1.29; P = 0.012) followed by those with poorly differentiated histology (HR 1.09, 95% CI 1.04-1.11; P = 0.029).Conclusions In pancreatic adenocarcinoma patients with LN disease, survival after PD is comparable regardless of HALN status. Therefore, HALN-positive disease should not preclude the performance of PD.

AB - Background Hepatic artery lymph node (HALN) metastasis in pancreatic adenocarcinoma reportedly confers a survival disadvantage. This has led some authors to propose it as an indicator against pancreaticoduodenectomy (PD).Methods Consecutive patients who underwent PD during 2002-2012 were identified from the University of Louisville prospective hepatopancreaticobiliary database. Overall survival (OS) and disease-free survival (DFS) were estimated using Kaplan-Meier analysis. The log-rank test and multivariate Cox proportional hazards regression were used in further analyses.Results A total of 420 patients underwent PD during the period of study, of whom 197 had lymph node (LN) metastasis. Among these, 41 (20.8%) patients had disease-positive HALNs. The HALN was the only site of LN metastasis in only three of the 247 patients (1.2%). Median follow-up was 18.5 months (interquartile range: 4.1-28.2 months). Median OS and DFS were 22.7 months [95% confidence interval (CI) 19.0-26.3] and 12.6 months (95% CI 10.2-15.2). There was no significant difference in median OS between HALN-positive patients (18.4 months, 95% CI 12.3-24.0) and HALN-negative patients (19.7 months, 95% CI 16.7-22.6) (P = 0.659). On multivariate analysis, the hazard ratio (HR) of death was highest among patients with an LN ratio of >0.2 (HR 1.2, 95% CI 1.1-1.29; P = 0.012) followed by those with poorly differentiated histology (HR 1.09, 95% CI 1.04-1.11; P = 0.029).Conclusions In pancreatic adenocarcinoma patients with LN disease, survival after PD is comparable regardless of HALN status. Therefore, HALN-positive disease should not preclude the performance of PD.

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