Wentz SC, Zhao ZG, Shyr Y, Shi CJ, Merchant NB, Washington K, Xia F, Chakravarthy AB. Lymph node ratio and preoperative CA 19-9 levels predict overall survival and recurrence-free survival in patients with resected pancreatic adenocarcinoma. World J Gastrointest Oncol 2012; 4(10): 207-215 [PMID: 23444312 DOI: 10.4251/wjgo.v4.i10.207]
Corresponding Author of This Article
Sabrina C Wentz, MD, Fellow, Department of Pathology, The Johns Hopkins Hospital, 201 N. Broadway, Baltimore, MD 21231, United States. swentz3@jhmi.edu
Article-Type of This Article
Original Article
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World J Gastrointest Oncol. Oct 15, 2012; 4(10): 207-215 Published online Oct 15, 2012. doi: 10.4251/wjgo.v4.i10.207
Lymph node ratio and preoperative CA 19-9 levels predict overall survival and recurrence-free survival in patients with resected pancreatic adenocarcinoma
Sabrina C Wentz, Zhi-Guo Zhao, Yu Shyr, Chan-Juan Shi, Nipun B Merchant, Kay Washington, Fen Xia, A Bapsi Chakravarthy
Sabrina C Wentz, Department of Pathology, The Johns Hopkins Hospital, Baltimore, MD 21201, United States
Zhi-Guo Zhao, Yu Shyr, Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN 37215, United States
Chan-Juan Shi, Kay Washington, Department of Pathology, Vanderbilt University Medical Center, Nashville, TN 37215, United States
Nipun B Merchant, Department of Surgery, Vanderbilt University Medical Center, Nashville, TN 37215, United States
Fen Xia, A Bapsi Chakravarthy, Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, TN 37215, United States
Author contributions: Wentz SC contributed to study design, wrote the manuscript, staged tumors and acquired relevant data; Zhao ZG and Shyr Y performed all statistical evaluations; Shi CJ and Washington K provided patient tissue information and expert morphologic interpretation; Merchant NB provided editorial advice and patient information; Xia F and Chakravarthy AB designed this study and contributed to the manuscript.
Correspondence to: Sabrina C Wentz, MD, Fellow, Department of Pathology, The Johns Hopkins Hospital, 201 N. Broadway, Baltimore, MD 21231, United States. swentz3@jhmi.edu
Telephone: +1-410-5021355 Fax: +1-410-9550115
Received: April 4, 2012 Revised: September 27, 2012 Accepted: October 1, 2012 Published online: October 15, 2012
Abstract
AIM: Clinicopathologic factors predicting overall survival (OS) would help identify a subset to benefit from adjuvant therapy.
METHODS: One hundred and sixty-nine patients patients from 1984 to 2009 with curative resections for pancreatic adenocarcinoma were included. Tumors were staged by American Joint Committee on Cancer 7th edition criteria. Univariate and multivariable analyses were performed using Kaplan-Meier methodology or Cox proportional hazard models. Log-rank tests were performed. Statistical inferences were assessed by two-sided 5% significance level.
RESULTS: Median age was 67.1 (57.2-73.0) years with equal gender distribution. Tumors were in the head (89.3%) or body/tail (10.7%). On univariate analysis, adjuvant therapy, lymph node (LN) ratio, histologic grade, negative margin status, absence of peripancreatic extension, and T stage were associated with improved OS. Adjuvant therapy, LN ratio, histologic grade, number of nodes examined, negative LN status, and absence of peripancreatic extension were associated with improved recurrence-free survival (RFS). On multivariable analysis, LN ratio and carbohydrate antigen (CA) 19-9 levels were associated with OS. LN ratio was associated with RFS.
CONCLUSION: The LN ratio and CA 19-9 levels are independent prognostic factors following curative resections of pancreatic cancer.
