In a study performed by Park et al, univariate analysis indicated that tumor location was an important prognostic factor for OS, but the significance of tumor site as an independent prognostic indicator could not be proved in the multivariate analysis. Some studies have investigated the prognostic significance of tumor localization in pancreatic cancer patients, but there is currently no consensus. This study concluded that while the contribution of the number of positive nodes to survival was relatively small, LNR was strongly associated with survival, and thus, LNR provided a stronger and more accurate predictor of survival than the number of positive nodes. The analysis of Surveillance, Epidemiology, and End Results and MGH (Massachusetts General Hospital) in 10254 and 827 resected patients, respectively, showed that higher LNR (> 0.2) was associated with worse survival by univariate analysis, and in addition the hazard ratio (HR) raised proportionally when more lymph nodes were examined in multivariate analysis. Riediger et al, in 204 resected patients, reported that LNR was the strongest predictor of survival and they concluded that the routine estimation of the LNR may be helpful not only for the individual prediction of prognosis but also for the indication of adjuvant therapy. To resolve these limitations, recently LNR was proposed as a new prognostic factor by several authors to prevent the ‘stage migration’ phenomenon. In the TNM staging system, the number of resected lymph nodes may be very important, but node-positive patients are not a homogenous group, because stage migration may occur in resected pancreatic cancer patients. Recent studies have suggested that LNR may also be an important prognostic factor in pancreatic cancer. Lymph node ratio (LNR) may be more useful than nodal (N) status in prognostic subclassification of pancreatic adenocarcinomas after pancreatoduodenectomy. On the other hand, whether these patients with pancreatic carcinoma who underwent margin-positive resection have to be managed with aggressive treatment modalities has not been described. A positive resection margin after pancreatic resection is considered to be a poor prognostic factor, and some have proposed that an R1 margin may be a biologic predictor of more aggressive disease. ![]() Median survival time was better in R0-resected patients compared with R1-resected patients (22 mo vs 15 mo). ![]() The R1-positive margin was localized at the retroperitoneal resection margin in 76% and at the trans-section margin in 14% of tumors. In addition, multivariate analysis showed that high mean operative blood loss and large tumor size were independent predictors of an R1 resection, but margin status did not independently influence survival.Īnother study including 265 pancreatic carcinoma patients who had undergone surgical resection reported that R1 resection in 49 patients (51%) and R2 resection in four patients (4%) were performed. In a study performed by Raut et al, they reported that the rate of R1 resection was 16.7% and patients who underwent an R1 resection had a median overall survival (OS) of 21.5 mo compared with 27.8 mo in patients who underwent an R0 resection. Menon et al reported that of 27 patients with pancreatic cancer, 22 patients underwent R1 resection and the median survival rate for patients with R1 resection was significantly worse than that of patients with R0 resection (14 mo vs not reached). The incidence of R1 resection has been indicated as being 20% in the literature, but the improvement of pathological work-up procedures has increased the rate of R1 resection up to 80%. Surgical resection is the only potentially curative option for treatment of pancreatic cancer and the nature of surgery for resectable tumors depends on the tumor localization and size. In this article, the prognostic factors affecting survival of patients with pancreatic cancer were reviewed. So it is important to determine new biological or pathological indicators related to survival in addition to well-known prognostic factors such as clinical and pathological stage, performance status, and surgical margin. ![]() Therefore, identifying poor prognostic factors that may predict the tumor recurrence and prognosis of patients is important for selecting appropriate treatment protocols. The primary goals of chemotherapy for metastatic disease are palliation and improved survival. Chemotherapy is used in the adjuvant setting and in the treatment of locally advanced inoperable and metastatic disease. Although surgical resection is the only curative treatment of choice for pancreatic cancer, unfortunately, the majority of patients are diagnosed at an advanced stage, and thus only 10%-15% of them are suitable for curative resection and the overall survival is less than 5%. Pancreatic adenocarcinoma still remains a major public health issue and is the fourth leading cause of cancer-related death worldwide.
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