OncologyPrognostic relevance of lymph node ratio and total lymph node count for small bowel adenocarcinoma
Section snippets
Methods
The Surveillance, Epidemiology, and End Results (SEER) database was used to identify patients diagnosed with small bowel adenocarcinoma in the United States from 1988 to 2010. SEER is a population-based database of the National Cancer Institute on cancer incidence and survival. SEER comprises approximately 28% of the US population with cancer. Data in the SEER database include demographic characteristics, tumor size, depth of tumor invasion, surgery, LN count, number of positive LNs, and
Results
A total of 2,773 patients with histologic diagnosis of small bowel adenocarcinoma met the inclusion criteria for the study. Clinicopathologic characteristics are detailed in Table I. The primary site of small bowel adenocarcinoma was distributed evenly between duodenal and jejunoileal cancers (each 50%). No differences were observed in tumor differentiation, number of LN examined, and number of positive LN between the 2 sites. Patients with duodenal cancers were slightly older than those with
Discussion
Adenocarcinoma of the small intestine presents a therapeutic challenge, given its relative rarity and advanced stage of diagnosis. Although it is intuitive that examination of more LNs would translate into more reliable pathologic staging, the survival advantage of retrieving more LNs has not been substantiated. Using the SEER database, we found that both LNR and the number of LNs examined were strong predictors of survival. Even after we controlled for patient and tumor characteristics, the
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2019, Surgical Oncology Clinics of North AmericaCitation Excerpt :The importance of lymphadenectomy in adenocarcinoma is important, as greater lymph node retrieval for duodenal adenocarcinoma may be independently associated with improved survival.21,22 Studies have shown that adequate staging requires a minimum of 5 lymph nodes for duodenal adenocarcinoma, and 9 lymph nodes for jejunoileal adenocarcinoma.21 Although more radical resection (pancreaticoduodenectomy) offers a significantly greater lymph node retrieval, segmental resection of the tumor has been shown to have an equal survival benefit.23
Comparison of three lymph node staging schemes for predicting the outcome in patients with small bowel adenocarcinoma: A population-based cohort and international multicentre cohort study
2019, EBioMedicineCitation Excerpt :The prognostic superiority of the LODDS and LODDS classification was also validated in an international multicenter cohort using the same inclusion and exclusion criteria. Lymph node status is a vital prognostic indicator of SBA [11,24,25]. The AJCC TNM staging currently dominates lymph node staging systems; however, the reliability of the pN staging scheme has recently been questioned.
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