J Korean Med Sci.  2011 Jul;26(7):881-885. 10.3346/jkms.2011.26.7.881.

Clinical Implications of Immunohistochemically Demonstrated Lymph Node Micrometastasis in Resectable Pancreatic Cancer

• Lee SE
• Jang JY
• Kim MA
• Kim SW

• KMID: 1094258
• DOI: http://doi.org/10.3346/jkms.2011.26.7.881

Abstract

The purpose of this study was to determine the clinical significance of nodal micrometastasis detected by immunohistochemistry in patients that had undergone curative surgery for pancreatic cancer. Between 2005 and 2006, a total of 208 lymph nodes from 48 consecutive patients with pancreatic cancer that had undergone curative resection were immunostained with monoclonal antibody against pan-ck and CK-19. Micrometastasis was defined as metastasis missed by a routine H&E examination but detected during an immunohistochemical evaluation. Relations between immunohistochemical results and clinical and pathologic features and patient survival were examined. Nodal micrometastases were detected in 5 (29.4%) patients of 17 pN0 patients. Nodal micrometastasis was found to be related to tumor relapse (P = 0.043). Twelve patients without overt nodal metastasis and micrometastasis had better prognosis than 5 patients with only nodal micrometastasis (median survival; 35.9 vs 8.6 months, P < 0.001). The Cox proportional hazard model identified nodal micrometastasis as significant prognostic factors. Although the number of patients with micrometastasis was so small and further study would be needed, our study suggests that the lymph node micrometastasis could be the predictor of worse survival and might indicate aggressive tumor biology among patients undergoing curative resection for pancreas cancer.

Keyword

Pancreas; Adenocarcinoma; Lymph Nodes; Micrometastasis; Prognosis

MeSH Terms

Aged
Antibodies, Monoclonal/immunology
Female
Humans
Immunohistochemistry
Keratin-19/immunology/metabolism
Lymph Nodes/pathology
Lymphatic Metastasis
Male
Middle Aged
Pancreatic Neoplasms/mortality/*pathology/surgery
Prognosis
Survival Rate

Figure

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  Fig. 1 Overall survival graph. Outcome after resection for patients without nodal micrometastasis compared favorably with those with nodal micrometastasis (P = 0.008).

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  Fig. 2 Overall survival graph. The outcome after resection in patients with neither overt nodal metastasis nor nodal micrometastasis compared favorably with those with no overt nodal metastasis and nodal micrometastasis (P < 0.001).

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