TY - JOUR
T1 - Determining the optimal number of examined lymph nodes for accurate staging of pancreatic cancer
T2 - An analysis using the nodal staging score model
AU - Hua, Jie
AU - Zhang, Bo
AU - Xu, Jin
AU - Liu, Jiang
AU - Ni, Quanxing
AU - He, Jin
AU - Zheng, Lei
AU - Yu, Xianjun
AU - Shi, Si
N1 - Funding Information:
This work was supported by the National Science Fund for Distinguished Young Scholars of China (grant number 81625016), the National Natural Science Foundation of China (grant number 81772555), and the Shanghai Sailing Program (grant number 17YF1402500).The authors thank Xueying Zheng (Department of Biostatistics and Key Laboratory of Public Health Safety, School of Public Health, Fudan University), Yu Zhang (School of Statistics, Renmin University of China), and Shuyue Chen (PBC School of Finance, Tsinghua University) for providing statistical support. The authors also thank the National Cancer Institute for providing the SEER data set.
Funding Information:
This work was supported by the National Science Fund for Distinguished Young Scholars of China (grant number 81625016 ), the National Natural Science Foundation of China (grant number 81772555 ), and the Shanghai Sailing Program (grant number 17YF1402500 ).
Publisher Copyright:
© 2019 The Authors
PY - 2019/6
Y1 - 2019/6
N2 - Introduction: The aim of this study was to determine the optimal number of examined lymph nodes (ELNs) for accurate staging of pancreatic cancer using the nodal staging score model. Materials and methods: Clinicopathological data for patients with resected pancreatic cancer were collected from SEER database (development cohort [DC]) and Fudan University Shanghai Cancer Center database (validation cohort [VC]). Multivariable models were constructed to assess how the number of ELNs was associated with stage migration and overall survival (OS). Using the β-binomial distribution, we developed a nodal staging score model from the DC and tested it with the VC. Results: Both cohorts exhibited significant proportional increases from node-negative to node-positive disease (DC: odds ratio [OR], 1.047; P < 0.001; VC: OR, 1.035; P < 0.001) and improved OS (DC: hazard ratio [HR], 0.982; P < 0.001; VC: HR, 0.979; P < 0.001) as ELNs increased. Nodal staging scores escalated separately as ELNs increased for different tumor (T) stages, with plateaus at 16, 21, and 23 LNs (cut-offs) for T1, T2, and T3 tumors, respectively. Multivariable analysis indicated that examining more LNs than the corresponding cut-off value was a significant survival predictor (DC: HR, 0.813; P < 0.001; VC: HR, 0.696; P = 0.028). Conclusion: The optimal number of ELNs for adequate staging of pancreatic cancer was related to T stage. We recommend examining at least 16, 21, and 23 LNs for T1, T2, and T3 tumors, respectively, as a nodal staging quality measure for both surgery and pathological analysis.
AB - Introduction: The aim of this study was to determine the optimal number of examined lymph nodes (ELNs) for accurate staging of pancreatic cancer using the nodal staging score model. Materials and methods: Clinicopathological data for patients with resected pancreatic cancer were collected from SEER database (development cohort [DC]) and Fudan University Shanghai Cancer Center database (validation cohort [VC]). Multivariable models were constructed to assess how the number of ELNs was associated with stage migration and overall survival (OS). Using the β-binomial distribution, we developed a nodal staging score model from the DC and tested it with the VC. Results: Both cohorts exhibited significant proportional increases from node-negative to node-positive disease (DC: odds ratio [OR], 1.047; P < 0.001; VC: OR, 1.035; P < 0.001) and improved OS (DC: hazard ratio [HR], 0.982; P < 0.001; VC: HR, 0.979; P < 0.001) as ELNs increased. Nodal staging scores escalated separately as ELNs increased for different tumor (T) stages, with plateaus at 16, 21, and 23 LNs (cut-offs) for T1, T2, and T3 tumors, respectively. Multivariable analysis indicated that examining more LNs than the corresponding cut-off value was a significant survival predictor (DC: HR, 0.813; P < 0.001; VC: HR, 0.696; P = 0.028). Conclusion: The optimal number of ELNs for adequate staging of pancreatic cancer was related to T stage. We recommend examining at least 16, 21, and 23 LNs for T1, T2, and T3 tumors, respectively, as a nodal staging quality measure for both surgery and pathological analysis.
KW - Examined lymph nodes
KW - Nodal staging score
KW - Pancreatic cancer
KW - Stage migration
KW - Survival
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U2 - 10.1016/j.ejso.2019.01.018
DO - 10.1016/j.ejso.2019.01.018
M3 - Article
C2 - 30685327
AN - SCOPUS:85060330101
VL - 45
SP - 1069
EP - 1076
JO - European Journal of Surgical Oncology
JF - European Journal of Surgical Oncology
SN - 0748-7983
IS - 6
ER -