Number of lymph nodes evaluated:Prognostic value in pancreatic adenocarcinoma

Marianne Huebner, Michael Kendrick, Kaye M. Reid-Lombardo, Florencia Que, Terry Therneau, Rui Qin, John Donohue, David Nagorney, Michael Farnell, Michael Sarr

Research output: Contribution to journalArticlepeer-review

82 Scopus citations


Introduction The impact of the number of lymph node (LN) evaluated pathologically on accurate staging is unknown. Our primary aim was to determine a minimum number of evaluated LN needed to provide accurate staging of pancreatic cancer. Methods Four hundred ninety-nine patients underwent a curative pancreatectomy for pancreatic adenocarcinoma cancer from 1981-2007. The probability of understaging a patient as N0 was estimated based on the number of LN evaluated. The prognostic value of LN ratio (LNR) was assessed.Results Survival for node-negative (pN0) patients with <11 LN examined was worse than for pN0 patients with ≥11 LNs with a hazard ratio (95 % CI) of 1.33 (1.1-1.7, p00.01) with 3-year survivals of 32 vs. 50%, respectively.Three-year survival for pN1 patients with <11 nodes evaluated was similar to pN1 patients with ≥11 nodes (25 vs. 30%).LNR≥0.17 predicted worse survival with hazard ratio of 1.76 (1.3-2.4, p00.001) than LNR<0.17; 3-year survivals were 37 vs. 19%.Conclusion Patients with "N0"disease with <11 LN evaluated pathologically have worse survival, suggesting that metastatic nodes were missed by evaluating too few nodes.For pN1 patients, LNR stratifies survival of patient cohorts more accurately.Adequate staging of pancreatic cancer requires pathologic evaluation of ≥11 LNs.

Original languageEnglish (US)
Pages (from-to)920-926
Number of pages7
JournalJournal of Gastrointestinal Surgery
Issue number5
StatePublished - May 2012


  • Cancer specific survival
  • Lymph node ratio
  • Lymphnode metastasis
  • Pancreatic cancer
  • Pathologic staging

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology


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