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The influence of total nodes examined, number of positive nodes, and lymph node ratio on survival after surgical resection and adjuvant chemoradiation for pancreatic cancer: a secondary analysis of RTOG 9704.

Publication ,  Journal Article
Showalter, TN; Winter, KA; Berger, AC; Regine, WF; Abrams, RA; Safran, H; Hoffman, JP; Benson, AB; MacDonald, JS; Willett, CG
Published in: Int J Radiat Oncol Biol Phys
December 1, 2011

PURPOSE: Lymph node status is an important predictor of survival in pancreatic cancer. We performed a secondary analysis of Radiation Therapy Oncology Group (RTOG) 9704, an adjuvant chemotherapy and chemoradiation trial, to determine the influence of lymph node factors--number of positive nodes (NPN), total nodes examined (TNE), and lymph node ratio (LNR ratio of NPN to TNE)--on OS and disease-free survival (DFS). PATIENT AND METHODS: Eligible patients from RTOG 9704 form the basis of this secondary analysis of lymph node parameters. Actuarial estimates for OS and DFS were calculated using Kaplan-Meier methods. Cox proportional hazards models were performed to evaluate associations of NPN, TNE, and LNR with OS and DFS. Multivariate Cox proportional hazards models were also performed. RESULTS: There were 538 patients enrolled in the RTOG 9704 trial. Of these, 445 patients were eligible with lymph nodes removed. Overall median NPN was 1 (min-max, 0-18). Increased NPN was associated with worse OS (HR=1.06, p=0.001) and DFS (HR=1.05, p=0.01). In multivariate analyses, both NPN and TNE were associated with OS and DFS. TNE>12, and >15 were associated with increased OS for all patients, but not for node-negative patients (n=142). Increased LNR was associated with worse OS (HR=1.01, p<0.0001) and DFS (HR=1.006, p=0.002). CONCLUSION: In patients who undergo surgical resection followed by adjuvant chemoradiation, TNE, NPN, and LNR are associated with OS and DFS. This secondary analysis of a prospective, cooperative group trial supports the influence of these lymph node parameters on outcomes after surgery and adjuvant therapy using contemporary techniques.

Duke Scholars

Published In

Int J Radiat Oncol Biol Phys

DOI

EISSN

1879-355X

Publication Date

December 1, 2011

Volume

81

Issue

5

Start / End Page

1328 / 1335

Location

United States

Related Subject Headings

  • Survival Analysis
  • Proportional Hazards Models
  • Pancreaticoduodenectomy
  • Pancreatic Neoplasms
  • Oncology & Carcinogenesis
  • Middle Aged
  • Male
  • Lymphatic Metastasis
  • Lymph Nodes
  • Lymph Node Excision
 

Citation

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MLA
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Showalter, T. N., Winter, K. A., Berger, A. C., Regine, W. F., Abrams, R. A., Safran, H., … Willett, C. G. (2011). The influence of total nodes examined, number of positive nodes, and lymph node ratio on survival after surgical resection and adjuvant chemoradiation for pancreatic cancer: a secondary analysis of RTOG 9704. Int J Radiat Oncol Biol Phys, 81(5), 1328–1335. https://doi.org/10.1016/j.ijrobp.2010.07.1993
Showalter, Timothy N., Kathryn A. Winter, Adam C. Berger, William F. Regine, Ross A. Abrams, Howard Safran, John P. Hoffman, Al B. Benson, John S. MacDonald, and Christopher G. Willett. “The influence of total nodes examined, number of positive nodes, and lymph node ratio on survival after surgical resection and adjuvant chemoradiation for pancreatic cancer: a secondary analysis of RTOG 9704.Int J Radiat Oncol Biol Phys 81, no. 5 (December 1, 2011): 1328–35. https://doi.org/10.1016/j.ijrobp.2010.07.1993.
Showalter, Timothy N., et al. “The influence of total nodes examined, number of positive nodes, and lymph node ratio on survival after surgical resection and adjuvant chemoradiation for pancreatic cancer: a secondary analysis of RTOG 9704.Int J Radiat Oncol Biol Phys, vol. 81, no. 5, Dec. 2011, pp. 1328–35. Pubmed, doi:10.1016/j.ijrobp.2010.07.1993.
Showalter TN, Winter KA, Berger AC, Regine WF, Abrams RA, Safran H, Hoffman JP, Benson AB, MacDonald JS, Willett CG. The influence of total nodes examined, number of positive nodes, and lymph node ratio on survival after surgical resection and adjuvant chemoradiation for pancreatic cancer: a secondary analysis of RTOG 9704. Int J Radiat Oncol Biol Phys. 2011 Dec 1;81(5):1328–1335.
Journal cover image

Published In

Int J Radiat Oncol Biol Phys

DOI

EISSN

1879-355X

Publication Date

December 1, 2011

Volume

81

Issue

5

Start / End Page

1328 / 1335

Location

United States

Related Subject Headings

  • Survival Analysis
  • Proportional Hazards Models
  • Pancreaticoduodenectomy
  • Pancreatic Neoplasms
  • Oncology & Carcinogenesis
  • Middle Aged
  • Male
  • Lymphatic Metastasis
  • Lymph Nodes
  • Lymph Node Excision