ORIGINAL RESEARCH article
Front. Surg.
Sec. Surgical Oncology
Volume 12 - 2025 | doi: 10.3389/fsurg.2025.1605726
SEER-based hypothesis-generating research for minimum lymph node evaluation in early-stage pancreatic ductal adenocarcinoma patients
Provisionally accepted
- Beijing University of Chinese Medicine, Beijing, China
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Background: The invasive ductal carcinoma of the pancreas (IDCP) is one of the most lethal malignancies in all solid cancers and regional lymph nodes contribute to recurrent carcinoma of IDCP. Given the dismal prognosis of IDCP, the impact of the number of ELNs on prognosis is particularly vital. However, the optimal number of examined lymph node for stage I, II IDCP patients has not been defined by the 7th and 8th edition of the American Joint Committee on Cancer (AJCC). Methods: All patients diagnosed with invasive ductal carcinoma type pancreatic cancer were extracted from the SEER database (http://seer.cancer.gov/) using SEER*Stat Software (version 8.3.9.2). The Minimum ELN or ELNs/RNP Ratio threshold for optimal survival of IDCP patients were calculated by R package "survminer" and "survival" and propensity score matching (PSM). Subgroup survival analysis of the best cut-off values for ELNs was assessed in age >69 years, age <=69 years, female, male, N0, N1, T3, stage I or II. We used a machine learning model (XGboost) to demonstrate that ELNs are a most significant prognostic factor in patients with IDCP. We also demonstrated significant prognostic effects and predictive models for the truncated values of ELNs using multivariate Cox-regression, Finally, we assessed the correlation between ELNs/RNP ratio and IDCPs mortality using restricted cubic spline (RCS). Results: The present study demonstrates the following points: (1) ELNs are one of the most important factors affecting the prognosis of Stage I and II IDCP patients. (2) ELNs>= 10 is the minimum cut-off value for Stage I and II IDCP patients to achieve the best survival, and this threshold is more suitable for surgical treatment options for Stage II IDCP patients. (3) ELNs>12 is the optimal threshold of survival benefit for T3N1M0 patients and ELNs>7 is for T3N0M0 patients. (4) Taking consideration the effect of the number of RNP on the value of ELNs, ELNs/RNP ratio = 9 is the minimum threshold for optimal survival benefit in IDCP patients with stage I and II.
Keywords: Pancreatic Cancer, Invasive ductal carcinoma of the pancreas (IDCP), Examined lymph node (ELNs), Regional nodes positive (RNP), ELNs/RNP, Optimal cut-off values for ELNs
Received: 03 Apr 2025; Accepted: 15 Oct 2025.
Copyright: © 2025 Xu, Huang, Yan, Xiao, Wang, Wang, Ge and Huang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Guangrui Huang, hgr@bucm.edu.cn
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