Detailed Abstract
[E-poster - Biliary & Pancreas (Pancreas Disease/Surgery)]
[EP 130] Applicability of Current Nodal Staging System for Borderline Resectable And Locally Advanced Pancreatic Cancer
Woohyung LEE 1, Jeein PARK 2, Minkyu SUNG 1, Kwang Pyo HONG 1, Yejong PARK 1, Bong Jun KWAK 1, Ki Byung SONG 1, Dae Wook HWANG 1, Jae Hoon LEE 1, Song Cheol KIM 1
1 Division of Hepatobiliary And Pancreatic Surgery, Department of Surgery, Asan Medical Center, REPUBLIC OF KOREA, 2 College of Medicine, University of Ulsan, REPUBLIC OF KOREA
Background : There has been little research on whether current nodal staging systems (NSS) can be applied to patients with surgery after neoadajuvant chemotherapy (NACT) for pancreatic cancer (PDAC). This study was aimed to evaluate the prognostic performance of NSS based on the number of metastatic lymph nodes (MLN), and lymph node ratio (metastatic/retrieved nodes; LNR) in such patients.
Methods : The patients who underwent surgery for PDAC between 2017 and 2020 were included; 730 and 347 patients underwent upfront and conversion surgery, respectively. Subgroups of each NSS were classified by K-adaptive partition and prognostic performance was compared using time-dependent areas under the curve (AUC) between upfront and NACT groups.
Results : The number of retrieved lymph nodes in NACT group was higher than upfront group (22.3 vs 19.0, p < 0.001). Patients without node metastasis were more frequent in the NACT group. (55.3% vs. 47.4%, p = 0.05). Patients were subgrouped by MLN (0, 1-3, ≥4) and LNR (0, 0-0.23, ≥0.23), and they showed differences of survival between each stage (p<0.001). Furthermore, both NSS demonstrated comparable performance between two groups (AUC for MLN, upfront vs. NACT: 0.693 vs. 0.623, AUC for LNR: 0.692 vs. 0.620). Both NSS were prognostic in upfront group regardless of the extent of resection, whereas their performance in NACT group were limited in patients with distal pancreatectomy (p>0.05).
Conclusions : Both MLN and LNR systems are prognostic for survival in patients with surgery after NACT, while they have limited role in patients who underwent distal pancreatectomy after NACT.
Methods : The patients who underwent surgery for PDAC between 2017 and 2020 were included; 730 and 347 patients underwent upfront and conversion surgery, respectively. Subgroups of each NSS were classified by K-adaptive partition and prognostic performance was compared using time-dependent areas under the curve (AUC) between upfront and NACT groups.
Results : The number of retrieved lymph nodes in NACT group was higher than upfront group (22.3 vs 19.0, p < 0.001). Patients without node metastasis were more frequent in the NACT group. (55.3% vs. 47.4%, p = 0.05). Patients were subgrouped by MLN (0, 1-3, ≥4) and LNR (0, 0-0.23, ≥0.23), and they showed differences of survival between each stage (p<0.001). Furthermore, both NSS demonstrated comparable performance between two groups (AUC for MLN, upfront vs. NACT: 0.693 vs. 0.623, AUC for LNR: 0.692 vs. 0.620). Both NSS were prognostic in upfront group regardless of the extent of resection, whereas their performance in NACT group were limited in patients with distal pancreatectomy (p>0.05).
Conclusions : Both MLN and LNR systems are prognostic for survival in patients with surgery after NACT, while they have limited role in patients who underwent distal pancreatectomy after NACT.
SESSION
E-poster
E-Session 03/21 ALL DAY