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World J Gastroenterol. Oct 28, 2006; 12(40): 6515-6521
Published online Oct 28, 2006. doi: 10.3748/wjg.v12.i40.6515
Strong prognostic value of nodal and bone marrow micro-involvement in patients with pancreatic ductal carcinoma receiving no adjuvant chemotherapy
Emre F Yekebas, Dean Bogoevski, Michael Bubenheim, Björn-Christian Link, Jussuf T Kaifi, Robin Wachowiak, Oliver Mann, Asad Kutup, Guellue Cataldegirmen, Lars Wolfram, Andreas Erbersdobler, Christoph Klein, Klaus Pantel, Jakob R Izbicki
Emre F Yekebas, Dean Bogoevski, Björn-Christian Link, Jussuf T Kaifi, Robin Wachowiak, Oliver Mann, Asad Kutup, Guellue Cataldegirmen, Lars Wolfram, Jakob R Izbicki, Department of General, Visceral and Thoracic Surgery, University Medical Centre of Hamburg-Eppendorf, Hamburg, Germany
Michael Bubenheim, Institute of Medical Biometry and Epidemiology, University Medical Centre of Hamburg-Eppendorf, Hamburg, Germany
Andreas Erbersdobler, Institute of Pathology, University Medical Centre of Hamburg-Eppendorf, Hamburg, Germany
Klaus Pantel, Institute of Tumor Biology, University Medical Centre of Hamburg-Eppendorf, Hamburg, Germany
Christoph Klein, Institute of Immunology, University of Munich, Munich, Germany
Supported by the “Hamburger Krebsgesellschaft e. V.”(06-04-2004) , the Roggenbuck-Stiftung, Hamburg (05-07-2004), and the Deutsche Forschungsgemeinschaft, Bonn, Germany
Correspondence to: Jakob R Izbicki, MD, FACS, Department of General, Visceral and Thoracic Surgery, University Medical Centre of Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany. izbicki@uke.uni-hamburg.de
Telephone: +49-40-428032401 Fax: +49-40-4280344319
Received: April 18, 2006
Revised: August 12, 2006
Accepted: September 13, 2006
Published online: October 28, 2006
Abstract

AIM: To study the prognostic value of adjuvant chemo-therapy in patients with pancreatic, ductal adenocar-cinoma.

METHODS: Lymph nodes from 106 patients with resectable pancreatic ductal adenocarcinoma were systematically sampled. A total of 318 lymph nodes classified histopathologically as tumor-free were examined using sensitive immunohistochemical assays. Forty-three (41%) of the 106 patients were staged as pT1/2, 63 (59%) as pT3/4, 51 (48%) as pN0, and 55 (52%) as pN1. The study population included 59 (56%) patients exhibiting G1/2, and 47 (44%) patients with G3 tumors. Patients received no adjuvant chemo- or radiation therapy and were followed up for a median of 12 (range: 3.5 to 139) mo.

RESULTS: Immunostaining with Ber-EP4 revealed nodal microinvolvement in lymph nodes classified as “tumor free” by conventional histopathology in 73 (69%) out of the 106 patients. Twenty-nine (57%) of 51 patients staged histopathologically as pN0 had nodal microinvolvement. The five-year survival probability for pN0-patients was 54% for those without nodal microinvolvement and 0% for those with nodal microinvolvement. Cox-regression modeling revealed the independent prognostic effect of nodal microinvolvement on recurrence-free (relative risk 2.92, P = 0.005) and overall (relative risk 2.49, P = 0.009) survival.

CONCLUSION: The study reveals strong and independent prognostic significance of nodal microinvolvement in patients with pancreatic ductal adenocarcinoma who have received no adjuvant therapy. The addition of immunohistochemical findings to histopathology reports may help to improve risk stratification of patients with pancreatic cancer.

Keywords: Pancreatic ductal adenocarcinoma, Nodal microinvolvement, Micrometastases