The Influence of Total Nodes Examined, Number of Positive Nodes, and Lymph Node Ratio on Survival After Surgical Resection and Adjuvant Chemoradiation for Pancreatic Cancer: A Secondary Analysis of RTOG 9704

Journal Article · Thu Dec 01 04:00:00 EST 2011 · International Journal of Radiation Oncology, Biology and Physics

DOI:https://doi.org/10.1016/J.IJROBP.2010.07.1993· OSTI ID:22054481

Showalter, Timothy N ^[1]; Winter, Kathryn A ^[2]; Regine, William F ^[3]; Abrams, Ross A ^[4]; Safran, Howard ^[5]; Hoffman, John P ^[6]; Benson, Al B ^[7]; MacDonald, John S ^[8]; Willett, Christopher G ^[9]

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1. Department of Radiation Oncology, Jefferson Medical College, Thomas Jefferson University, Philadelphia, PA (United States)
2. Radiation Therapy Oncology Group, RTOG Statistical Center, Philadelphia, PA (United States)
3. Department of Radiation Oncology, University of Maryland Medical Center, Baltimore, MD (United States)
4. Department of Radiation Oncology, Rush University Medical Center, Chicago, IL (United States)
5. Department of Medicine, Miriam Hospital, Brown University Oncology Group, Providence, RI (United States)
6. Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA (United States)
7. Division of Hematology-Oncology, Northwestern University, Chicago, IL (United States)
8. St. Vincent's Cancer Care Center, New York, NY (United States)
9. Department of Radiation Oncology, Duke University Medical Center, Durham, NC (United States)

Purpose: Lymph node status is an important predictor of survival in pancreatic cancer. We performed a secondary analysis of Radiation Therapy Oncology Group (RTOG) 9704, an adjuvant chemotherapy and chemoradiation trial, to determine the influence of lymph node factors-number of positive nodes (NPN), total nodes examined (TNE), and lymph node ratio (LNR ratio of NPN to TNE)-on OS and disease-free survival (DFS). Patient and Methods: Eligible patients from RTOG 9704 form the basis of this secondary analysis of lymph node parameters. Actuarial estimates for OS and DFS were calculated using Kaplan-Meier methods. Cox proportional hazards models were performed to evaluate associations of NPN, TNE, and LNR with OS and DFS. Multivariate Cox proportional hazards models were also performed. Results: There were 538 patients enrolled in the RTOG 9704 trial. Of these, 445 patients were eligible with lymph nodes removed. Overall median NPN was 1 (min-max, 0-18). Increased NPN was associated with worse OS (HR = 1.06, p = 0.001) and DFS (HR = 1.05, p = 0.01). In multivariate analyses, both NPN and TNE were associated with OS and DFS. TNE > 12, and >15 were associated with increased OS for all patients, but not for node-negative patients (n = 142). Increased LNR was associated with worse OS (HR = 1.01, p < 0.0001) and DFS (HR = 1.006, p = 0.002). Conclusion: In patients who undergo surgical resection followed by adjuvant chemoradiation, TNE, NPN, and LNR are associated with OS and DFS. This secondary analysis of a prospective, cooperative group trial supports the influence of these lymph node parameters on outcomes after surgery and adjuvant therapy using contemporary techniques.

• OSTI ID: 22054481
• Journal Information: International Journal of Radiation Oncology, Biology and Physics, Journal Name: International Journal of Radiation Oncology, Biology and Physics Journal Issue: 5 Vol. 81; ISSN IOBPD3; ISSN 0360-3016
• Country of Publication: United States
• Language: English

Related Subjects

62 RADIOLOGY AND NUCLEAR MEDICINE
CHEMOTHERAPY
HAZARDS
LYMPH NODES
MULTIVARIATE ANALYSIS
NEOPLASMS
PANCREAS
PATIENTS
RADIOTHERAPY
SURGERY