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

Fiona Speichinger; Mihnea P. Dragomir; Simon Schallenberg; Florian N. Loch; Claudius E. Degro; Ann-Kathrin Baukloh; Lisa Hartmann; Ioannis Pozios; Christian Schineis; Georgios Antonios Margonis; Johannes C. Lauscher; Katharina Beyer; Carsten Kamphues

doi:10.3390/cancers14010201

Cancers (Dec 2021)

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

Fiona Speichinger,
Mihnea P. Dragomir,
Simon Schallenberg,
Florian N. Loch,
Claudius E. Degro,
Ann-Kathrin Baukloh,
Lisa Hartmann,
Ioannis Pozios,
Christian Schineis,
Georgios Antonios Margonis,
Johannes C. Lauscher,
Katharina Beyer,
Carsten Kamphues

Affiliations

Fiona Speichinger: Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt–Universität zu Berlin, Department of General and Visceral Surgery, Hindenburgdamm 30, 12203 Berlin, Germany
Mihnea P. Dragomir: Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Institute of Pathology, 10117 Berlin, Germany
Simon Schallenberg: Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Institute of Pathology, 10117 Berlin, Germany
Florian N. Loch: Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt–Universität zu Berlin, Department of General and Visceral Surgery, Hindenburgdamm 30, 12203 Berlin, Germany
Claudius E. Degro: Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt–Universität zu Berlin, Department of General and Visceral Surgery, Hindenburgdamm 30, 12203 Berlin, Germany
Ann-Kathrin Baukloh: Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt–Universität zu Berlin, Department of General and Visceral Surgery, Hindenburgdamm 30, 12203 Berlin, Germany
Lisa Hartmann: Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt–Universität zu Berlin, Department of General and Visceral Surgery, Hindenburgdamm 30, 12203 Berlin, Germany
Ioannis Pozios: Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt–Universität zu Berlin, Department of General and Visceral Surgery, Hindenburgdamm 30, 12203 Berlin, Germany
Christian Schineis: Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt–Universität zu Berlin, Department of General and Visceral Surgery, Hindenburgdamm 30, 12203 Berlin, Germany
Georgios Antonios Margonis: Department of Surgery, The Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Blalock 688, Baltimore, MD 21287, USA
Johannes C. Lauscher: Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt–Universität zu Berlin, Department of General and Visceral Surgery, Hindenburgdamm 30, 12203 Berlin, Germany
Katharina Beyer: Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt–Universität zu Berlin, Department of General and Visceral Surgery, Hindenburgdamm 30, 12203 Berlin, Germany
Carsten Kamphues: Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt–Universität zu Berlin, Department of General and Visceral Surgery, Hindenburgdamm 30, 12203 Berlin, Germany

DOI: https://doi.org/10.3390/cancers14010201
Journal volume & issue: Vol. 14, no. 1
p. 201

Abstract

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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.

Published in Cancers

ISSN: 2072-6694 (Online)
Publisher: MDPI AG
Country of publisher: Switzerland
LCC subjects: Medicine: Internal medicine: Neoplasms. Tumors. Oncology. Including cancer and carcinogens
Website: https://www.mdpi.com/journal/cancers/

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