Lymph node ratio and preoperative CA 19-9 levels predict overall survival and recurrence-free survival in patients with resected pancreatic adenocarcinoma

Table 1 Patient demographics n (%)

Gender
Female	78 (46.2)
Male	91 (53.8)
Ethnicity
African American	8 (4.7)
Caucasian	146 (86.4)
Unknown	15 (8.9)
Tumor location
Head	151 (89.3)
Body/tail	18 (10.7)
Operation type
Whipple	150 (88.8)
Distal pancreatectomy	12 (7.1)
Total pancreatectomy	5 (2.9)
En bloc resection	2 (1.2)
Adjuvant therapy
Chemoradiation	72 (42.6)
Chemotherapy	33 (19.5)
Radiation	3 (1.8)
None	50 (29.6)
Unknown	11 (6.5)
Age at surgery (yr) (n = 169)	67.1 (57.2-73.0)1
Followup range (m) (n = 169)	0.13-156.6

The total number of patients is 169.

¹Median (interquartile range).

Table 2 Clinicopathologic characteristics n (%)

Resection margin
Negative	122 (72.2)
Positive	47 (27.8)
Perineural invasion
Negative	41 (24.2)
Positive	127 (75.1)
Unknown	1 (0.6)
Peripancreatic extension
Negative	28 (16.6)
Positive	141 (83.4)
Unknown	1 (0.6)
TNM stage
I	16 (9.5)
IIA	39 (23.1)
IIB	98 (58.0)
III	10 (5.9)
IV	5 (3.0)
Unknown	1 (0.6)
Tumor grade
1	24 (14.2)
2	94 (55.6)
3	48 (28.4)
Unknown	4 (2.4)
LN examined (n = 167)2	11.0 (7.5-18)1
LN positive (n = 167)2	1.0 (0.0-4.0)1
LN examined (n = 150)3	12.0 (8.0-18.0)1
LN positive (n = 150)3	1.0 (0.0-4.0)1
LN ratio (n = 167)	0.09 (0.0-0.29)1
Tumor size (cm) (n = 167)	3.0 (2.1-3.6)1
CA 19-9 (U/mL) (n = 124)	146.0 (47.5-378.2)1

The total number of patients is 169.

¹Median (interquartile range);

²All procedures;

³Whipple procedures. TNM: Tumor-node-metastasis; LN: Lymph node; CA: Carbohydrate antigen.

Table 3 Patient outcomes n (%)

Recurrence status (n= 169)
Recurred	124 (73.3)
No recurrence	45 (26.6)
Recurrence location (n = 124)
Local	21 (16.9)
Distant	66 (53.2)
Local and distant	7 (5.6)
Unknown	30 (24.2)
Overall survival time (mo)	15.1 (8.0-33.5)1
Time to recurrence (mo)	9.8 (5.1-21.1)1
Disease-related survival status (n = 169)
Death from disease	104 (62.5)
Death from other causes	19 (11.2)
Alive with disease	21 (12.4)
Alive with no disease	25 (14.8)

¹Median (interquartile range).

Table 4 Hazard ratios of clinicopathologic variables analyzed on univariate analysis for overall survival and recurrence-free survival

	Overall survival			Recurrence-free survival
	HR	95% CI	P value	HR	95% CI	P value
Age at surgery (73 yr vs 57.2 yr)	1.43	1.05-1.94	0.021	1.22	0.91-1.64	0.188
Gender
Female	1			1
Male	1.06	0.74-1.51	0.76	1.02	0.71-1.45	0.934
Tumor location
Head	1			1
Body/tail	1.26	0.73-2.16	0.406	1.66	0.96-2.86	0.07
Operation type
Whipple	1			1
Distal pancreatectomy	0.88	0.44-1.73	0.704	1.56	0.81-2.99	0.184
Total pancreatectomy	0.56	0.14-2.27	0.417	0.88	0.28-2.79	0.832
En bloc resection	1.73	0.54-5.46	0.354	1.92	0.61-6.08	0.267
Adjuvant therapy
Chemoradiation	1			1
Chemotherapy	1.09	0.67-1.79	0.722	1.14	0.71-1.83	0.587
Radiation	0.73	0.1-5.32	0.758	0.98	0.24-4.04	0.98
None	1.89	1.26-2.84	0.002	1.55	1.02-2.37	0.041
Resection margin
Negative	1			1
Positive	1.99	1.35-2.94	0.001	1.38	0.93-2.06	0.114
Perineural invasion
Negative	1			1
Positive	1.22	0.79-1.88	0.372	0.93	0.62-1.41	0.736
Peripancreatic extension
Negative	1			1
Positive	2.23	1.27-3.91	0.005	2	1.16-3.45	0.013
TNM stage
I-IIA	1			1
IIB-IV	2	1.33-3.02	0.001	1.87	1.25-2.8	0.002
Tumor grade
I	1			1
II-III	2.43	1.34-4.42	0.004	2.24	1.28-3.92	0.005
LN examined (18 vs 7.5)	1.21	0.95-1.55	0.132	1.4	1.09-1.81	0.012
LN positive (4 vs 0)	1.52	1.26-1.83	0	1.57	1.3-1.9	< 0.001
LN ratio (0.29 vs 0)	1.44	1.18-1.76	0.001	1.57	1.27-1.95	< 0.001
Tumor size (3.5 vs 2.1)	1.08	0.95-1.23	0.279	1.2	1.07-1.34	0.007
CA 19-9 (378.25 vs 47.5)	1.04	1-1.07	0.075	1.02	0.99-1.06	0.238

HR: Hazards ratio; TNM: Tumor-node-metastasis; LN: Lymph node; CA: Carbohydrate antigen.

Table 5 Hazard ratios of variables analyzed on multivariable analysis for overall survival and recurrence-free survival

	Overall survival			Recurrence-free survival
	HR	95% CI	P value	HR	95% CI	P value
Lymph node ratio (0.29 vs 0)	1.66	1.226-2.225	< 0.001	1.50	1.109-2.028	0.008
Preoperative CA 19-9 (378.25 vs 47.5)	1.27	1.001-1.619	0.049	1.24	0.97-1.584	0.086
Tumor grade (I vs II-III)	0.91	0.539-1.532	0.720	1.38	0.813-2.344	0.232
Perineural invasion (Neg vs Pos)	0.54	0.256-1.145	0.108	0.45	0.204-1.002	0.050
Adjuvant chemotherapy (no vs yes)	1.48	0.876-2.505	0.142	1.32	0.744-2.357	0.339

HR: Hazards ratio; CA: Carbohydrate antigen; Neg: Negative; Pos: Positive.