Accuracy of Nodal Positivity in Inadequate Lymphadenectomy in Pancreaticoduodenectomy for Pancreatic Ductal Adenocarcinoma: A Population Study Using the US SEER Database
Objectives: The optimal number of the examined lymph nodes (ELNs) in pancreaticoduodenectomy for pancreatic ductal adenocarcinoma has been widely studied. However, the accuracy of nodal positivity for the patients with inadequate lymphadenectomy is still unclear. The purpose of our study was to dete...
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| Format: | Article |
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Frontiers Media S.A.
2019-12-01
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| Series: | Frontiers in Oncology |
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| Online Access: | https://www.frontiersin.org/article/10.3389/fonc.2019.01386/full |
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| author | Weishen Wang Ziyun Shen Yusheng Shi Siyi Zou Ningzhen Fu Yu Jiang Zhiwei Xu Hao Chen Xiaxing Deng Baiyong Shen |
| author_facet | Weishen Wang Ziyun Shen Yusheng Shi Siyi Zou Ningzhen Fu Yu Jiang Zhiwei Xu Hao Chen Xiaxing Deng Baiyong Shen |
| author_sort | Weishen Wang |
| collection | DOAJ |
| description | Objectives: The optimal number of the examined lymph nodes (ELNs) in pancreaticoduodenectomy for pancreatic ductal adenocarcinoma has been widely studied. However, the accuracy of nodal positivity for the patients with inadequate lymphadenectomy is still unclear. The purpose of our study was to determine the accuracy of the number of positive nodes reported for patients with 1–3 positive nodes and the probability that 4 or more nodes could be positive along with tumor size and number of nodes examined.Methods: We obtained data on patients who underwent pancreaticoduodenectomy for resectable pancreatic ductal adenocarcinoma diagnosed during 2004–2013 from the US Surveillance, Epidemiology, and End Results registry. An mathematical model based on Hypergeometric Distribution and Bayes' Theorem was used to estimate the accuracy.Results: Among the 9,945 patients, 55.6% underwent inadequate lymphadenectomy. Of them, 1,842, 6,049, and 2,054 had T1, T2, and T3 stage disease, respectively. The accuracy of the number of observed positive nodes increased as the number of ELNs increased and the tumor size decreased. To rule out the possibility of N2 stage (4 and more positive nodes), there should be at least 13 ELNs for the patients with 1 observed positive lymph node and 14 for the patients with 2.Conclusion: Inadequate lymphadenectomy could result in underestimation of the N stage, and this would have adverse impact on recurrence, efficacy of postoperative treatment, and even overall survival. This model combined with the observed positive lymph nodes, the number of ELNs, and tumor size could provide a more accurate determination of nodal positivity of these patients. |
| first_indexed | 2024-12-21T12:02:22Z |
| format | Article |
| id | doaj.art-1c54c501345b41168b7307228dbd94bf |
| institution | Directory Open Access Journal |
| issn | 2234-943X |
| language | English |
| last_indexed | 2024-12-21T12:02:22Z |
| publishDate | 2019-12-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Oncology |
| spelling | doaj.art-1c54c501345b41168b7307228dbd94bf2022-12-21T19:04:47ZengFrontiers Media S.A.Frontiers in Oncology2234-943X2019-12-01910.3389/fonc.2019.01386494293Accuracy of Nodal Positivity in Inadequate Lymphadenectomy in Pancreaticoduodenectomy for Pancreatic Ductal Adenocarcinoma: A Population Study Using the US SEER DatabaseWeishen WangZiyun ShenYusheng ShiSiyi ZouNingzhen FuYu JiangZhiwei XuHao ChenXiaxing DengBaiyong ShenObjectives: The optimal number of the examined lymph nodes (ELNs) in pancreaticoduodenectomy for pancreatic ductal adenocarcinoma has been widely studied. However, the accuracy of nodal positivity for the patients with inadequate lymphadenectomy is still unclear. The purpose of our study was to determine the accuracy of the number of positive nodes reported for patients with 1–3 positive nodes and the probability that 4 or more nodes could be positive along with tumor size and number of nodes examined.Methods: We obtained data on patients who underwent pancreaticoduodenectomy for resectable pancreatic ductal adenocarcinoma diagnosed during 2004–2013 from the US Surveillance, Epidemiology, and End Results registry. An mathematical model based on Hypergeometric Distribution and Bayes' Theorem was used to estimate the accuracy.Results: Among the 9,945 patients, 55.6% underwent inadequate lymphadenectomy. Of them, 1,842, 6,049, and 2,054 had T1, T2, and T3 stage disease, respectively. The accuracy of the number of observed positive nodes increased as the number of ELNs increased and the tumor size decreased. To rule out the possibility of N2 stage (4 and more positive nodes), there should be at least 13 ELNs for the patients with 1 observed positive lymph node and 14 for the patients with 2.Conclusion: Inadequate lymphadenectomy could result in underestimation of the N stage, and this would have adverse impact on recurrence, efficacy of postoperative treatment, and even overall survival. This model combined with the observed positive lymph nodes, the number of ELNs, and tumor size could provide a more accurate determination of nodal positivity of these patients.https://www.frontiersin.org/article/10.3389/fonc.2019.01386/fullpancreatic ductal adenocarcinoma (PDAC)pancreaticoduodenectomy (PD)inadequate lymphadenectomysurveillance epidemiology and end results (SEER)examined lymph nodes |
| spellingShingle | Weishen Wang Ziyun Shen Yusheng Shi Siyi Zou Ningzhen Fu Yu Jiang Zhiwei Xu Hao Chen Xiaxing Deng Baiyong Shen Accuracy of Nodal Positivity in Inadequate Lymphadenectomy in Pancreaticoduodenectomy for Pancreatic Ductal Adenocarcinoma: A Population Study Using the US SEER Database Frontiers in Oncology pancreatic ductal adenocarcinoma (PDAC) pancreaticoduodenectomy (PD) inadequate lymphadenectomy surveillance epidemiology and end results (SEER) examined lymph nodes |
| title | Accuracy of Nodal Positivity in Inadequate Lymphadenectomy in Pancreaticoduodenectomy for Pancreatic Ductal Adenocarcinoma: A Population Study Using the US SEER Database |
| title_full | Accuracy of Nodal Positivity in Inadequate Lymphadenectomy in Pancreaticoduodenectomy for Pancreatic Ductal Adenocarcinoma: A Population Study Using the US SEER Database |
| title_fullStr | Accuracy of Nodal Positivity in Inadequate Lymphadenectomy in Pancreaticoduodenectomy for Pancreatic Ductal Adenocarcinoma: A Population Study Using the US SEER Database |
| title_full_unstemmed | Accuracy of Nodal Positivity in Inadequate Lymphadenectomy in Pancreaticoduodenectomy for Pancreatic Ductal Adenocarcinoma: A Population Study Using the US SEER Database |
| title_short | Accuracy of Nodal Positivity in Inadequate Lymphadenectomy in Pancreaticoduodenectomy for Pancreatic Ductal Adenocarcinoma: A Population Study Using the US SEER Database |
| title_sort | accuracy of nodal positivity in inadequate lymphadenectomy in pancreaticoduodenectomy for pancreatic ductal adenocarcinoma a population study using the us seer database |
| topic | pancreatic ductal adenocarcinoma (PDAC) pancreaticoduodenectomy (PD) inadequate lymphadenectomy surveillance epidemiology and end results (SEER) examined lymph nodes |
| url | https://www.frontiersin.org/article/10.3389/fonc.2019.01386/full |
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