Evidence map›Paper›PMID 30187332›Full record

ArticleJournal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract2019

Lymph Node Ratio in Pancreatic Adenocarcinoma After Preoperative Chemotherapy vs. Preoperative Chemoradiation and Its Utility in Decisions About Postoperative Chemotherapy.

Douglas S Swords, Samual R Francis, Shane Lloyd, Ignacio Garrido-Laguna, Sean J Mulvihill, Joshua D Gruhl, Miles C Christensen, Gregory J Stoddard, Matthew A Firpo, Courtney L Scaife

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Article in Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.

0numbers the graph read from it
0cells of the map it votes in
7citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

7 citing papers in PubMed.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Douglas S SwordsDivision of General Surgery, Department of Surgery, University of Utah, 30 North 1900 East, Salt Lake City, UT, 84132, USA. douglas.swords@hsc.utah.edu.ORCID 0000-0002-5002-6992
Samual R FrancisDepartment of Radiation Oncology, University of Utah, Salt Lake City, UT, USA.
Shane LloydDepartment of Radiation Oncology, University of Utah, Salt Lake City, UT, USA.
Ignacio Garrido-LagunaDivision of Medical Oncology, Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA.
Sean J MulvihillDivision of General Surgery, Department of Surgery, University of Utah, 30 North 1900 East, Salt Lake City, UT, 84132, USA.
Joshua D GruhlDepartment of Radiation Oncology, University of Utah, Salt Lake City, UT, USA.
Miles C ChristensenDepartment of Radiation Oncology, University of Utah, Salt Lake City, UT, USA.
Gregory J StoddardDivision of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA.
Matthew A FirpoDivision of General Surgery, Department of Surgery, University of Utah, 30 North 1900 East, Salt Lake City, UT, 84132, USA.
Courtney L ScaifeDivision of General Surgery, Department of Surgery, University of Utah, 30 North 1900 East, Salt Lake City, UT, 84132, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundSingle-center studies in pancreatic adenocarcinoma have suggested that preoperative chemotherapy (PCT) is associated with higher lymph node ratio (LNR) than preoperative chemoradiation (PCRT). The association of postoperative chemotherapy with overall survival (OS) in patients treated with PCT and PCRT remains unclear. Our objectives were to investigate whether (1) PCT is associated with higher LNR than PCRT and (2) postoperative chemotherapy is associated with longer OS after PCT and PCRT in LNR-stratified cohorts.

methodsA retrospective cohort study was performed of patients with pancreatic adenocarcinoma treated with PCT or PCRT followed by resection between 2006 and 2014 in the National Cancer Database. Temporal trends were evaluated with Cuzick's test. OS was evaluated with multivariable Cox regression and inverse probability weighted (IPW) Cox regression.

resultsOf 4187 patients, 1993 (47.6%) received PCT. PCT rates were stable at approximately 30% in 2006-2010 (p = 0.33) but increased to 64.9% by 2014 (p < 0.001). Node positivity rates were higher after PCT than PCRT (62.7 vs. 41.8%, P < 0.001) and mean LNR was higher (0.10 [95% CI 0.096, 0.11] vs. 0.058 [95% CI 0.052, 0.063], P < 0.001). Postoperative chemotherapy was associated with longer OS in patients with LNR 0.01-0.149 after PCT by univariate analysis (median OS 34.5 vs. 26.5 months, P = 0.002), multivariable Cox regression (HR 0.64, 95% CI 0.48, 0.84), and IPW Cox regression (HR 0.72, 95% CI 0.55, 0.94). Postoperative chemotherapy was not associated with longer OS for patients who were node-negative or who had LNR ≥ 0.15 after PCT or for any patient subgroups after PCRT.

conclusionsPCT is associated with a higher LNR and higher rates of node positivity than PCRT. Postoperative chemotherapy is associated with longer OS than observation in patients with a LNR of 0.01-0.149 after PCT.

Indexed as

Lymph Node RatioAdolescentAdultAgedAged, 80 and overCarcinoma, Pancreatic DuctalChemoradiotherapyChemotherapy, AdjuvantClinical Decision-MakingFemaleHumansLymph NodesMaleMiddle AgedPancreatic NeoplasmsRetrospective StudiesAdjuvantChemoradiationChemotherapyLNRLymph node ratioNeoadjuvantNodal statusPancreatic adenocarcinomaPDACPostoperativePreoperative

Identifiers

PMID30187332

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.