Rethinking the TNM Classification Regarding Direct Lymph Node Invasion in Pancreatic Ductal Adenocarcinoma

Mechanisms of lymph node invasion seem to play a prognostic role in pancreatic ductal adenocarcinoma (PDAC) after resection. However, the 8th edition of the TNM classification of the American Joint Committee on Cancer (AJCC) does not consider this. The aim of this study was to analyse the prognostic role of different mechanisms of lymph node invasion on PDAC. One hundred and twenty-two patients with resected PDAC were examined. We distinguished three groups: direct (per continuitatem, Nc) from the main tumour, metastasis (Nm) without any contact to the main tumour, and a mixed mechanism (Ncm). Afterwards, the prognostic power of the different groups was analysed concerning overall survival (OS). In total, 20 patients displayed direct lymph node invasion (Nc = 16.4%), 44 were classed as Nm (36.1%), and 21 were classed as Ncm (17.2%). The difference in OS was not statistically significant between N0 (no lymph node metastasis, n = 37) and Nc (p = 0.134), while Nm had worse OS than N0 (p < 0.001). Direct invasion alone had no statistically significant effect on OS (p = 0.885). Redefining the N0 stage by including Nc patients showed a more precise OS prediction among N stages (p = 0.001 vs. p = 0.002). Nc was more similar to N0 than to Nm; hence, we suggest a rethinking of TNM classification based on the mechanisms of lymph node metastases in PDAC. Overall, this novel classification is more precise.

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Pancreatoduodenectomy should be avoided when para-aortic lymph node metastases are found during surgical exploration for suspected pancreatic ductal adenocarcinoma

HPB ◽

10.1016/j.hpb.2018.06.2192 ◽

2018 ◽

Vol 20 ◽

pp. S623

Author(s):

B. Pranger ◽

D. Tseng ◽

S. Ubels ◽

G. Patijn ◽

I.H. Borel Rinkes ◽

...

Keyword(s):

Lymph Node ◽

Pancreatic Ductal Adenocarcinoma ◽

Lymph Node Metastases ◽

Ductal Adenocarcinoma ◽

Surgical Exploration ◽

Aortic Lymph Node ◽

Node Metastases

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Prognostic Role of Neutrophil-to-Lymphocyte Ratio in Advanced Pancreatic Ductal Adenocarcinoma: Impact of Baseline Fluctuation and Changes during Chemotherapy

Tumori Journal ◽

10.1177/030089161309900413 ◽

2013 ◽

Vol 99 (4) ◽

pp. 516-522 ◽

Cited By ~ 10

Author(s):

MinYuen Teo ◽

Mohd Syahizul Nuhairy Mohd Sharial ◽

Felicity McDonnell ◽

Kevin C Conlon ◽

Paul F Ridgway ◽

...

Keyword(s):

Pancreatic Ductal Adenocarcinoma ◽

Neutrophil To Lymphocyte Ratio ◽

Ductal Adenocarcinoma ◽

Prognostic Role ◽

Lymphocyte Ratio

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Prognostic Role of High-Grade Tumor Budding in Pancreatic Ductal Adenocarcinoma: A Systematic Review and Meta-Analysis with a Focus on Epithelial to Mesenchymal Transition

Cancers ◽

10.3390/cancers11010113 ◽

2019 ◽

Vol 11 (1) ◽

pp. 113 ◽

Cited By ~ 11

Author(s):

Rita Lawlor ◽

Nicola Veronese ◽

Alessia Nottegar ◽

Giuseppe Malleo ◽

Lee Smith ◽

...

Keyword(s):

Systematic Review ◽

Pancreatic Ductal Adenocarcinoma ◽

Epithelial To Mesenchymal Transition ◽

Meta Analysis ◽

Tumor Budding ◽

Ductal Adenocarcinoma ◽

High Grade ◽

Prognostic Role ◽

Mesenchymal Transition

This study aims at clarifying the prognostic role of high-grade tumor budding (TB) in pancreatic ductal adenocarcinoma (PDAC) with the first systematic review and meta-analysis on this topic. Furthermore, we analyzed with a systematic review the relationship between TB and a recently suggested TB-associated mechanism: the epithelial to mesenchymal transition (EMT). Analyzing a total of 613 patients, 251 of them (40.9%) with high grade-TB, we found an increased risk of all-cause mortality (RR, 1.46; 95% CI, 1.13–1.88, p = 0.004; HR, 2.65; 95% CI, 1.79–3.91; p < 0.0001) and of recurrence (RR, 1.61; 95% CI, 1.05–2.47, p = 0.03) for PDAC patients with high-grade TB. Moreover, we found that EMT is a central process in determining the presence of TB in PDAC. Thanks to this meta-analysis, we demonstrate the potential clinical significance of high-grade TB for prognostic stratification of PDAC. TB also shows a clear association with the process of EMT. Based on the results of the present study, TB should be conveyed in pathology reports and taken into account by future oncologic staging systems.

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