The Prognostic Significance of the Station 8a Lymph Regional Node in Resectable Adenocarcinoma of the Pancreatic Head

Document Type

Conference Proceeding

Publication Date

3-19-2022

Publication Title

Mod Pathol

Abstract

Background: Regional lymph node status is an important prognostic factor of overall survival (OS) for pancreatic ductal adenocarcinoma (PDAC) patients undergoing pancreaticoduodenectomy (PD) with curative intent. Among regional lymph nodes of the pancreatic head/uncinate, the station 8a lymph node is present along the anteriosuperior aspect of the common hepatic artery and is often harvested during PD. However, the prognostic significance of metastatic spread to the station 8a lymph node is unclear. We, therefore, examined the clinicopathologic features and OS with respect to the status of the station 8a lymph node for PDAC patients. Design: In total, 595 consecutive PDs with an excised station 8a lymph node were reviewed and assessed for: patient age, gender, neoadjuvant and adjuvant treatment, tumor size, histologic grade, perineural and lymphovascular invasion, T- and N-stage, number of positive lymph nodes, positive lymph node ratio, surgical resection margins, and OS. Results: Lymph node metastasis was identified for 430 (72%) patients, and 203 (34%) patients had 4 or more positive lymph nodes (pN2). Metastatic disease involving the station 8a lymph node was identified in 82 (14%) cases and, for lymph node-positive patients, station 8a metastasis correlated with larger tumor size, advanced N-stage, greater positive lymph nodes, and a higher positive lymph node ratio (p<0.02). In fact, 62 (of 82, 76%) station 8a-positive patients had pN2 disease. The 1- and 3-year OS rates for pN2 patients with and without station 8a lymph node metastasis were 50% and 8%, and 66% and 20%, respectively (p=0.006). Based on multivariate analysis, station 8a lymph node metastasis was a negative prognostic factor for OS (p=0.020) and was independent of patient age, histologic grade, perineural and lymphovascular invasion, advanced T-stage and N-stage, positive resection margins, and both neoadjuvant and adjuvant therapy. Similarly, among pN2 patients, a positive station 8a lymph node was a negative prognostic factor for OS (p<0.001) and was independent of patient age, histologic grade, perineural and lymphovascular invasion, advanced T-stage and N-stage, positive resection margins, and both neoadjuvant and adjuvant therapy. Conclusions: Station 8a lymph node metastasis for PDAC patients is associated with adverse clinicopathologic features, and an independent predictor of poor patient OS. Thus, a positive station 8a lymph node is prognostically relevant and should be considered when reporting lymph node status.

PubMed ID

Not assigned.

Volume

35

Issue

SUPPL 2

First Page

1217

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