Predictive Value of Lymph Node Ratio in Patients with Pancreatic Cancer Treated with Pancreatoduodenectomy

Background: Recently, the predictive value of lymph node ratio (LNR, the ratio of metastatic lymph nodes to total examined lymph nodes) has been evaluated in patients with gastrointestinal malignancies, including pancreatic cancer. However, there is not enough evidence about the prognostic value of this factor. Objectives: We aimed at determining the value of LNR in predicting the survival of patients who have undergone the Whipple procedure. Methods: This cohort study was performed on 96 patients with pancreatic cancer undergoing the Whipple procedure during 2014 - 2019. Demographic, clinical, and pathological data of the patients were extracted from their records and patients survival status was determined through follow-up. LNR and its effect on survival was calculated using the Cox model. Results: Of the 96 eligible patients, 51 (53.13%) were men. The mean age of the patients was 57.1 ± 14.1 (range: 19 - 82) years. The median total lymph nodes examined was 7 (range: 1 - 27), and no metastatic lymph nodes were found in 57 (59.37%) patients. The median involved lymph nodes and LNR were 2 and 0.17, respectively. Patients with LNR 0.20 had the lowest 1 and 3-year survival rates. Age (P = 0.04), surgical radial margin (P = 0.001), lymph node status (N0, N1) (P = 0.01), and LNR (P = 0.01) were the most important prognostic factors for survival. Conclusions: LNR is a valuable indicator that can be used in patients with lymph node involvement as a prognostic factor for poor survival after the Whipple procedure. The lowest 1, 3, and 5-year survival rates were seen in patients with LNR 0.20.