{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T19:21:31Z","timestamp":1792092091235,"version":"4.4.0"},"reference-count":51,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2015,1,27]],"date-time":"2015-01-27T00:00:00Z","timestamp":1422316800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2015,1,27]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>According to some studies, the number of lymph nodes with metastases in relation to the total number of removed lymph nodes, the lymph node ratio (LNR), is one of the most powerful predictors of survival after resection in patients with pancreatic cancer. However, contradictory results have been reported, and small sample sizes of the cohorts and different definitions of a microscopic positive resection margin (R1) hamper the interpretation of data.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>The predictive value of LNR for 3-year survival was assessed using a Cox proportional hazards model. From 1992 to 2012, all patients with pancreatic and periampullary cancer operated on with pancreatoduodenectomy were selected from a database. Clinicopathological characteristics were analysed. Microscopic positive resection margin was defined as the microscopic presence of tumour cells within 1 mm of the margins. A nomogram was created.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Some 760 patients were included. Predictive factors for death in 350 patients with pancreatic ductal adenocarcinoma included in the nomogram were: R1 resection (hazard ratio (HR) 1\u00b755, 95 per cent c.i. 1\u00b707 to 2\u00b725), poor tumour differentiation (HR 2\u00b778, 1\u00b740 to 5\u00b752), LNR above 0\u00b718 (HR 1\u00b775, 1\u00b713 to 2\u00b770) and no adjuvant therapy (HR 1\u00b754, 1\u00b701 to 2\u00b734). The C statistic was 0\u00b7658 (0\u00b7632 to 0\u00b7698), and calibration was good (Hosmer\u2013Lemeshow \u03c72 = 5\u00b767, P =0\u00b7773). LNR and poor tumour differentiation (HR 4\u00b751 and 3\u00b730 respectively) were also predictive in patients with distal common bile duct (CBD) cancer. LNR, R1 resection and jaundice were predictors of death in patients with ampullary cancer (HR 7\u00b782, 2\u00b768 and 1\u00b793 respectively).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>LNR is a common predictor of poor survival in pancreatic, distal CBD and ampullary cancer.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1002\/bjs.9709","type":"journal-article","created":{"date-parts":[[2014,12,22]],"date-time":"2014-12-22T10:44:46Z","timestamp":1419245086000},"page":"237-245","source":"Crossref","is-referenced-by-count":98,"title":["Impact of lymph node ratio on survival in patients with pancreatic and periampullary cancer"],"prefix":"10.1093","volume":"102","author":[{"given":"J A M G","family":"Tol","sequence":"first","affiliation":[{"name":"Departments of Surgery, Academic Medical Centre , Amsterdam,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L A A","family":"Brosens","sequence":"additional","affiliation":[{"name":"Departments of Pathology, Academic Medical Centre , Amsterdam,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S","family":"van Dieren","sequence":"additional","affiliation":[{"name":"Departments of Clinical Research Unit, Academic Medical Centre , Amsterdam,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"T M","family":"van Gulik","sequence":"additional","affiliation":[{"name":"Departments of Surgery, Academic Medical Centre , Amsterdam,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"O R C","family":"Busch","sequence":"additional","affiliation":[{"name":"Departments of Surgery, Academic Medical Centre , Amsterdam,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M G H","family":"Besselink","sequence":"additional","affiliation":[{"name":"Departments of Surgery, Academic Medical Centre , Amsterdam,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D J","family":"Gouma","sequence":"additional","affiliation":[{"name":"Departments of Surgery, Academic Medical Centre , Amsterdam,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2015,2,1]]},"reference":[{"key":"2024092914083860100_bjs9709-bib-0001","volume-title":"SEER Stat Fact Sheets: Pancreas Cancer","author":"Surveillance, Epidemiology, and End Results Program"},{"key":"2024092914083860100_bjs9709-bib-0002","doi-asserted-by":"crossref","first-page":"951","DOI":"10.1111\/hpb.12071","article-title":"Longterm survival after pancreaticoduodenectomy for periampullary adenocarcinomas","volume":"15","author":"Chen","year":"2013","journal-title":"HPB (Oxford)"},{"key":"2024092914083860100_bjs9709-bib-0003","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1186\/1471-2482-13-12","article-title":"Evaluation of survival in patients after pancreatic head resection for ductal adenocarcinoma","volume":"13","author":"Distler","year":"2013","journal-title":"BMC Surg"},{"key":"2024092914083860100_bjs9709-bib-0004","doi-asserted-by":"crossref","first-page":"e76052","DOI":"10.1371\/journal.pone.0076052","article-title":"The incidence and survival rate of population-based pancreatic cancer patients: Shanghai Cancer Registry 2004\u20132009","volume":"8","author":"Luo","year":"2013","journal-title":"PLoS One"},{"key":"2024092914083860100_bjs9709-bib-0005","doi-asserted-by":"crossref","first-page":"11","DOI":"10.3322\/caac.21166","article-title":"Cancer Statistics, 2013","volume":"63","author":"Siegel","year":"2013","journal-title":"CA Cancer J Clin"},{"key":"2024092914083860100_bjs9709-bib-0006","doi-asserted-by":"crossref","first-page":"991","DOI":"10.1245\/s10434-009-0883-9","article-title":"Predictors of survival in periampullary cancers following pancreaticoduodenectomy","volume":"17","author":"Hatzaras","year":"2010","journal-title":"Ann Surg Oncol"},{"key":"2024092914083860100_bjs9709-bib-0007","doi-asserted-by":"crossref","first-page":"549","DOI":"10.1016\/j.ejca.2003.10.026","article-title":"Surgical treatment of pancreatic adenocarcinoma; 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