Prognostic role of nodal ratio, LODDS, pN in patients with pancreatic cancer with venous involvement
Giovanni Ramacciato,
Giuseppe Nigri,
Niccolo’ Petrucciani,
Antonio Daniele Pinna,
Matteo Ravaioli,
Elio Jovine,
Francesco Minni,
Gian Luca Grazi,
Piero Chirletti,
Giuseppe Tisone,
Fabio Ferla,
Niccolo’ Napoli,
Ugo Boggi
Affiliations
Giovanni Ramacciato
Department of Medical and Surgical Sciences and Translational Medicine, Faculty of Medicine and Psychology, St Andrea Hospital, Sapienza University, General Surgery Unit
Giuseppe Nigri
Department of Medical and Surgical Sciences and Translational Medicine, Faculty of Medicine and Psychology, St Andrea Hospital, Sapienza University, General Surgery Unit
Niccolo’ Petrucciani
Department of Medical and Surgical Sciences and Translational Medicine, Faculty of Medicine and Psychology, St Andrea Hospital, Sapienza University, General Surgery Unit
Antonio Daniele Pinna
Department of Medical and Surgical Sciences-DIMEC, S. Orsola-Malpighi Hospital, Alma Mater Studiorum, University of Bologna, General Surgery and Transplantation Unit
Matteo Ravaioli
Department of Medical and Surgical Sciences-DIMEC, S. Orsola-Malpighi Hospital, Alma Mater Studiorum, University of Bologna, General Surgery and Transplantation Unit
Elio Jovine
General Surgery Unit, ‘Maggiore’ Hospital
Francesco Minni
Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum, S. Orsola-Malpighi Hospital, University of Bologna, General Surgery Unit
Gian Luca Grazi
Regina Elena National Cancer Institute IFO, Hepato-pancreato-biliary Surgery Unit
Piero Chirletti
Department of Surgical Sciences, Sapienza University of Rome, Policlinico Umberto I Hospital, General Surgery Unit
Giuseppe Tisone
Department of Experimental Medicine and Surgery, Liver Unit, Tor Vergata University of Rome
Fabio Ferla
Division of General Surgery and Transplantation Surgery, Niguarda Hospital
Niccolo’ Napoli
Division of General Surgery and Transplantation Surgery, Pisa University Hospital
Ugo Boggi
Division of General Surgery and Transplantation Surgery, Pisa University Hospital
Abstract Background The UICC/AJCC TNM staging system classifies lymph nodes as N0 and N1 in pancreatic cancer. Aim of the study is to determine whether the number of examine nodes, the nodal ratio (NR) and the logarithm odds of positive lymph nodes (LODDS) may better stratify the prognosis of patients undergoing pancreatectomy combined with venous resection for pancreatic cancer with venous involvement. Methods A multicenter database of 303 patients undergoing pancreatectomy in 9 Italian referral centers was analyzed. The prognostic impact of number of retrieved and examined nodes, NR, LODDS was analyzed and compared with ROC curves analysis, Pearson test, univariate and multivariate analysis. Results The number of metastatic nodes, pN, the NR and LODDS was significantly correlated with survival at multivariate analyses. The corresponding AUC for the number of metastatic nodes, pN, the NR and LODDS were 0.66, 0.69, 0.63 and 0.65, respectively. The Pearson test showed a significant correlation between the number of retrieved lymph nodes and number of metastatic nodes, pN and the NR. LODDS had the lower coefficient correlation. Concerning N1 patients, the NR, the LODDS and the number of metastatic nodes were able to significantly further stratify survival (p = 0.040; p = 0.046; p = 0.038, respectively). Conclusions The number of examined lymph nodes, the NR and LODDS are useful for further prognostic stratification of N1 patients in the setting of pancreatectomy combined with PV/SMV resection. No superiority of one over the others methods was detected.
