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Association Between Very Small Tumor Size and Decreased Overall Survival in Node-Positive Pancreatic Cancer

  • Pancreatic Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

In pancreatic adenocarcinoma (PDAC), increasing tumor size usually correlates with a worse prognosis. However, patients with a very small primary tumor who experience lymph node involvement may have a different disease biology. This study sought to determine the interaction between tumor size and lymph node involvement in terms of overall survival (OS).

Methods

The study identified 17,073 patients with a diagnosis of M0 resected PDAC between 1983 and 2013 using the Surveillance, Epidemiology, and End Results database. The patients were stratified by lymph node involvement (N0 vs N+) and T stage (T1a–T1b vs T1c vs T2 vs T3 vs T4). The Kaplan–Meier method was used to estimate OS, and Cox regression analysis was used to compare survival between subgroups after adjustment for patient-specific factors.

Results

Lymph node involvement and T stage significantly interacted (p < 0.001). Among the patients with node-negative disease, 5-year OS decreased monotonically with increasing T stage (59.1%, 30.6%, 22.9%, 16.6%, and 8.0%, respectively; p < 0.001). In contrast, among the patients with node-positive disease, those with T1a–T1b tumors (< 10 mm) had worse 5-year OS than those with T1c tumors (7.4% vs 17.6%; adjusted hazard ratio, 0.70; 95% confidence interval, 0.50–0.97; p = 0.034) and similar survival compared with those who had T2, T3, or T4 tumors (9.7%, 8.2%, and 4.8%, respectively; p > 0.2 in all cases).

Conclusions

Among patients with lymph node-positive PDAC, very small primary tumors are associated with decreased OS. This finding raises the possibility that small tumors capable of lymph node metastasis might represent more biologically aggressive cancers.

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Authors and Affiliations

  1. Harvard Radiation Oncology Program, Boston, MA, USA

    Vinayak Muralidhar MD, MSc

  2. Department of Medical Oncology, Massachusetts General Hospital, Boston, MA, USA

    Ryan D. Nipp MD & Aparna Parikh MD

  3. Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women’s Hospital, Boston, MA, USA

    Harvey J. Mamon MD, PhD, Rinaa S. Punglia MD, MPH & Paul L. Nguyen MD

  4. Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, USA

    Theodore S. Hong MD & Jennifer Y. Wo MD

  5. Department of Surgery, Massachusetts General Hospital, Boston, MA, USA

    Cristina Ferrone MD & Carlos Fernandez-del Castillo MD

Authors
  1. Vinayak Muralidhar MD, MSc
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  2. Ryan D. Nipp MD
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  3. Harvey J. Mamon MD, PhD
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  4. Rinaa S. Punglia MD, MPH
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  5. Theodore S. Hong MD
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  6. Cristina Ferrone MD
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  7. Carlos Fernandez-del Castillo MD
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  8. Aparna Parikh MD
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  9. Paul L. Nguyen MD
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  10. Jennifer Y. Wo MD
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Corresponding author

Correspondence to Jennifer Y. Wo MD.

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Disclosure

Dr. Nguyen has served as a consultant to GenomeDx, Astellas, Bayer, Ferring, Dandreon, Blue Earth, Augmenix, Janssen, and Nanobiotix. He has received research funding from Janssen and Astellas and has equity in Augmenix. No other authors have any conflicts of interest or disclosures.

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Muralidhar, V., Nipp, R.D., Mamon, H.J. et al. Association Between Very Small Tumor Size and Decreased Overall Survival in Node-Positive Pancreatic Cancer. Ann Surg Oncol 25, 4027–4034 (2018). https://doi.org/10.1245/s10434-018-6832-8

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  • DOI: https://doi.org/10.1245/s10434-018-6832-8

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