Adenocarcinoma of the duodenum: Importance of accurate lymph node staging and similarity in outcome to gastric cancer Journal Article
| Authors: | Sarela, A. I.; Brennan, M. F.; Karpeh, M. S.; Klimstra, D.; Conlon, K. C. |
| Article Title: | Adenocarcinoma of the duodenum: Importance of accurate lymph node staging and similarity in outcome to gastric cancer |
| Abstract: | Background: This study examined prognostic discrimination by lymph node staging for duodenal adenocarcinoma and compared the nodal stage-specific survival with that associated with gastric antral adenocarcinoma. Method: Prospectively maintained databases from 1983 to 2000 were reviewed to identify 137 patients with duodenal adenocarcinoma and 545 patients with gastric antral adenocarcinoma at a single institution. Results: R0 resection was performed for 72 patients with duodenal cancer. At least 15 lymph nodes were retrieved in 34 cases (47%). Lymph node metastasis (pN+) was detected in 31 patients (43%). With median follow-up of 36 months, the pN category was an independently significant prognostic factor (pN0, 5-year disease-specific survival of 83%, vs. pN+, 56%; P = .03). The survival difference between pN0 and pN + was pronounced in patients with ≥15 nodes (100% vs. 47%, respectively; P = .01) but was lost in those with <15 nodes (75% vs. 64%; P = .5). For gastric antrum cancer, 331 patients had R0 resection, and ≥15 nodes were retrieved in 256 cases (77%). Lymph node metastasis was detected in 157 cases (47%). For patients with ≥15 nodes, 5-year survival with pN0 (87%) or pN+ (44%) was not significantly different from the corresponding categories for duodenal adenocarcinoma. Conclusion: For duodenal adenocarcinoma, examination of ≥15 regional lymph nodes improved prognostic discrimination by the pN category. With accurate nodal staging, pN0 was associated with excellent prognosis. With pN+, prognosis was similar to that for gastric antral adenocarcinoma. © 2004 The Society of Surgical Oncology, Inc. |
| Keywords: | survival; adult; cancer survival; controlled study; aged; middle aged; survival analysis; cancer surgery; survival rate; major clinical study; mortality; review; cancer patient; cancer staging; follow up; lymph node metastasis; lymph nodes; lymphatic metastasis; neoplasm staging; prospective study; prospective studies; adenocarcinoma; accuracy; disease association; proportional hazards models; pathology; data base; survival time; proportional hazards model; lymph node; prediction and forecasting; predictive value of tests; outcomes research; chi-square distribution; stomach adenocarcinoma; stomach neoplasms; statistics, nonparametric; stomach tumor; stomach; chi square distribution; nonparametric test; health center; duodenal neoplasms; periampullary; stomach antrum; humans; prognosis; human; male; female; article; antrum; pancreatoduodenectomy; duodenum carcinoma; duodenum tumor |
| Journal Title: | Annals of Surgical Oncology |
| Volume: | 11 |
| Issue: | 4 |
| ISSN: | 1068-9265 |
| Publisher: | Springer |
| Date Published: | 2004-04-01 |
| Start Page: | 380 |
| End Page: | 386 |
| Language: | English |
| DOI: | 10.1245/aso.2004.05.021 |
| PROVIDER: | scopus |
| PUBMED: | 15070597 |
| DOI/URL: | |
| Notes: | Ann. Surg. Oncol. -- Cited By (since 1996):32 -- Export Date: 16 June 2014 -- CODEN: ASONF -- Source: Scopus |
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