Rethinking the TNM Classification Regarding Direct Lymph Node Invasion in Pancreatic Ductal Adenocarcinoma
Mechanisms of lymph node invasion seem to play a prognostic role in pancreatic ductal adenocarcinoma (PDAC) after resection. However, the 8th edition of the TNM classification of the American Joint Committee on Cancer (AJCC) does not consider this. The aim of this study was to analyse the prognostic...
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| Veröffentlicht in: | Cancers 2021-12, Vol.14 (1), p.201 |
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| creator | Speichinger, Fiona Dragomir, Mihnea P Schallenberg, Simon Loch, Florian N Degro, Claudius E Baukloh, Ann-Kathrin Hartmann, Lisa Pozios, Ioannis Schineis, Christian Margonis, Georgios Antonios Lauscher, Johannes C Beyer, Katharina Kamphues, Carsten |
| description | Mechanisms of lymph node invasion seem to play a prognostic role in pancreatic ductal adenocarcinoma (PDAC) after resection. However, the 8th edition of the TNM classification of the American Joint Committee on Cancer (AJCC) does not consider this. The aim of this study was to analyse the prognostic role of different mechanisms of lymph node invasion on PDAC. One hundred and twenty-two patients with resected PDAC were examined. We distinguished three groups: direct (per continuitatem, Nc) from the main tumour, metastasis (Nm) without any contact to the main tumour, and a mixed mechanism (Ncm). Afterwards, the prognostic power of the different groups was analysed concerning overall survival (OS). In total, 20 patients displayed direct lymph node invasion (Nc = 16.4%), 44 were classed as Nm (36.1%), and 21 were classed as Ncm (17.2%). The difference in OS was not statistically significant between N0 (no lymph node metastasis,
= 37) and Nc (
0.134), while Nm had worse OS than N0 (
0.001). Direct invasion alone had no statistically significant effect on OS (
0.885). Redefining the N0 stage by including Nc patients showed a more precise OS prediction among N stages (
0.001 vs.
0.002). Nc was more similar to N0 than to Nm; hence, we suggest a rethinking of TNM classification based on the mechanisms of lymph node metastases in PDAC. Overall, this novel classification is more precise. |
| doi_str_mv | 10.3390/cancers14010201 |
| format | Article |
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= 37) and Nc (
0.134), while Nm had worse OS than N0 (
0.001). Direct invasion alone had no statistically significant effect on OS (
0.885). Redefining the N0 stage by including Nc patients showed a more precise OS prediction among N stages (
0.001 vs.
0.002). Nc was more similar to N0 than to Nm; hence, we suggest a rethinking of TNM classification based on the mechanisms of lymph node metastases in PDAC. Overall, this novel classification is more precise.</description><identifier>ISSN: 2072-6694</identifier><identifier>EISSN: 2072-6694</identifier><identifier>DOI: 10.3390/cancers14010201</identifier><identifier>PMID: 35008365</identifier><language>eng</language><publisher>Switzerland: MDPI AG</publisher><subject>Adenocarcinoma ; Bile ducts ; Classification ; Lymph nodes ; Lymphatic system ; Medical prognosis ; Metastases ; Metastasis ; Mortality ; Pancreatic cancer ; Patients ; Small intestine ; Statistical analysis ; Surgery ; Survival analysis ; Tumors</subject><ispartof>Cancers, 2021-12, Vol.14 (1), p.201</ispartof><rights>2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2021 by the authors. 2021</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c421t-35c6ea6d2ab54b598fc5ab12e6ac632f411c4a20a66871a0338a70537cd07103</citedby><cites>FETCH-LOGICAL-c421t-35c6ea6d2ab54b598fc5ab12e6ac632f411c4a20a66871a0338a70537cd07103</cites><orcidid>0000-0001-7578-280X ; 0000-0002-5550-3516 ; 0000-0002-5406-8540 ; 0000-0002-0563-8826 ; 0000-0001-9189-6751 ; 0009-0003-3919-5175</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8750597/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8750597/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,881,27901,27902,53766,53768</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/35008365$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Speichinger, Fiona</creatorcontrib><creatorcontrib>Dragomir, Mihnea P</creatorcontrib><creatorcontrib>Schallenberg, Simon</creatorcontrib><creatorcontrib>Loch, Florian N</creatorcontrib><creatorcontrib>Degro, Claudius E</creatorcontrib><creatorcontrib>Baukloh, Ann-Kathrin</creatorcontrib><creatorcontrib>Hartmann, Lisa</creatorcontrib><creatorcontrib>Pozios, Ioannis</creatorcontrib><creatorcontrib>Schineis, Christian</creatorcontrib><creatorcontrib>Margonis, Georgios Antonios</creatorcontrib><creatorcontrib>Lauscher, Johannes C</creatorcontrib><creatorcontrib>Beyer, Katharina</creatorcontrib><creatorcontrib>Kamphues, Carsten</creatorcontrib><title>Rethinking the TNM Classification Regarding Direct Lymph Node Invasion in Pancreatic Ductal Adenocarcinoma</title><title>Cancers</title><addtitle>Cancers (Basel)</addtitle><description>Mechanisms of lymph node invasion seem to play a prognostic role in pancreatic ductal adenocarcinoma (PDAC) after resection. However, the 8th edition of the TNM classification of the American Joint Committee on Cancer (AJCC) does not consider this. The aim of this study was to analyse the prognostic role of different mechanisms of lymph node invasion on PDAC. One hundred and twenty-two patients with resected PDAC were examined. We distinguished three groups: direct (per continuitatem, Nc) from the main tumour, metastasis (Nm) without any contact to the main tumour, and a mixed mechanism (Ncm). Afterwards, the prognostic power of the different groups was analysed concerning overall survival (OS). In total, 20 patients displayed direct lymph node invasion (Nc = 16.4%), 44 were classed as Nm (36.1%), and 21 were classed as Ncm (17.2%). The difference in OS was not statistically significant between N0 (no lymph node metastasis,
= 37) and Nc (
0.134), while Nm had worse OS than N0 (
0.001). Direct invasion alone had no statistically significant effect on OS (
0.885). Redefining the N0 stage by including Nc patients showed a more precise OS prediction among N stages (
0.001 vs.
0.002). Nc was more similar to N0 than to Nm; hence, we suggest a rethinking of TNM classification based on the mechanisms of lymph node metastases in PDAC. Overall, this novel classification is more precise.</description><subject>Adenocarcinoma</subject><subject>Bile ducts</subject><subject>Classification</subject><subject>Lymph nodes</subject><subject>Lymphatic system</subject><subject>Medical prognosis</subject><subject>Metastases</subject><subject>Metastasis</subject><subject>Mortality</subject><subject>Pancreatic cancer</subject><subject>Patients</subject><subject>Small intestine</subject><subject>Statistical analysis</subject><subject>Surgery</subject><subject>Survival analysis</subject><subject>Tumors</subject><issn>2072-6694</issn><issn>2072-6694</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>8G5</sourceid><sourceid>BENPR</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNpdkctrGzEQxkVpaUKac29F0EsvTvRYSbuXQnD6CDgPgu9iPKu15e5KrrQbyH9fOUlDkrnMwPzmYz4-Qj5zdiJlw04RArqUecU4E4y_I4eCGTHTuqnev5gPyHHOW1ZKSm60-UgOpGKsllodku2tGzc-_PFhTceNo8urSzrvIWffeYTRx0Bv3RpSuwfOfXI40sX9sNvQq9g6ehHuIO8hH-hNeSe5coP0fMIRenrWuhAREvoQB_hEPnTQZ3f81I_I8ueP5fz3bHH962J-tphhJfg4kwq1A90KWKlqpZq6QwUrLpwG1FJ0FedYgWCgdW04FFM1GKakwZYZzuQR-f4ou5tWg2vRhTFBb3fJD5DubQRvX2-C39h1vLO1UUw1pgh8exJI8e_k8mgHn9H1PQQXp2yF5nXDGs5lQb--QbdxSqG4e6BKBI3khTp9pDDFnJPrnp_hzO6TtG-SLBdfXnp45v_nJv8Bb3ubRA</recordid><startdate>20211231</startdate><enddate>20211231</enddate><creator>Speichinger, Fiona</creator><creator>Dragomir, Mihnea P</creator><creator>Schallenberg, Simon</creator><creator>Loch, Florian N</creator><creator>Degro, Claudius E</creator><creator>Baukloh, Ann-Kathrin</creator><creator>Hartmann, Lisa</creator><creator>Pozios, Ioannis</creator><creator>Schineis, Christian</creator><creator>Margonis, Georgios Antonios</creator><creator>Lauscher, Johannes C</creator><creator>Beyer, Katharina</creator><creator>Kamphues, Carsten</creator><general>MDPI AG</general><general>MDPI</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7T5</scope><scope>7TO</scope><scope>7XB</scope><scope>8FE</scope><scope>8FH</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BHPHI</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>H94</scope><scope>HCIFZ</scope><scope>LK8</scope><scope>M2O</scope><scope>M7P</scope><scope>MBDVC</scope><scope>PHGZM</scope><scope>PHGZT</scope><scope>PIMPY</scope><scope>PKEHL</scope><scope>PQEST</scope><scope>PQGLB</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0001-7578-280X</orcidid><orcidid>https://orcid.org/0000-0002-5550-3516</orcidid><orcidid>https://orcid.org/0000-0002-5406-8540</orcidid><orcidid>https://orcid.org/0000-0002-0563-8826</orcidid><orcidid>https://orcid.org/0000-0001-9189-6751</orcidid><orcidid>https://orcid.org/0009-0003-3919-5175</orcidid></search><sort><creationdate>20211231</creationdate><title>Rethinking the TNM Classification Regarding Direct Lymph Node Invasion in Pancreatic Ductal Adenocarcinoma</title><author>Speichinger, Fiona ; 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However, the 8th edition of the TNM classification of the American Joint Committee on Cancer (AJCC) does not consider this. The aim of this study was to analyse the prognostic role of different mechanisms of lymph node invasion on PDAC. One hundred and twenty-two patients with resected PDAC were examined. We distinguished three groups: direct (per continuitatem, Nc) from the main tumour, metastasis (Nm) without any contact to the main tumour, and a mixed mechanism (Ncm). Afterwards, the prognostic power of the different groups was analysed concerning overall survival (OS). In total, 20 patients displayed direct lymph node invasion (Nc = 16.4%), 44 were classed as Nm (36.1%), and 21 were classed as Ncm (17.2%). The difference in OS was not statistically significant between N0 (no lymph node metastasis,
= 37) and Nc (
0.134), while Nm had worse OS than N0 (
0.001). Direct invasion alone had no statistically significant effect on OS (
0.885). Redefining the N0 stage by including Nc patients showed a more precise OS prediction among N stages (
0.001 vs.
0.002). Nc was more similar to N0 than to Nm; hence, we suggest a rethinking of TNM classification based on the mechanisms of lymph node metastases in PDAC. Overall, this novel classification is more precise.</abstract><cop>Switzerland</cop><pub>MDPI AG</pub><pmid>35008365</pmid><doi>10.3390/cancers14010201</doi><orcidid>https://orcid.org/0000-0001-7578-280X</orcidid><orcidid>https://orcid.org/0000-0002-5550-3516</orcidid><orcidid>https://orcid.org/0000-0002-5406-8540</orcidid><orcidid>https://orcid.org/0000-0002-0563-8826</orcidid><orcidid>https://orcid.org/0000-0001-9189-6751</orcidid><orcidid>https://orcid.org/0009-0003-3919-5175</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | Adenocarcinoma Bile ducts Classification Lymph nodes Lymphatic system Medical prognosis Metastases Metastasis Mortality Pancreatic cancer Patients Small intestine Statistical analysis Surgery Survival analysis Tumors |
| title | Rethinking the TNM Classification Regarding Direct Lymph Node Invasion in Pancreatic Ductal Adenocarcinoma |
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