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To the Editor: In their randomized controlled trial, Dr Regine and colleagues¹ compared the effects of gemcitabine and fluorouracil on survival after curative-intent resection of pancreatic adenocarcinoma followed by chemoradiation. The study found a survival benefit associated with the addition of gemcitabine, but this was not statistically significant. Of the patients, 66% had nodal metastases and 34% had microscopically positive margins, but lymph node examination rates and details about number of lymph nodes positive for metastatic cancer were not shown.

In a retrospective study including 905 patients who underwent pancreaticoduodenectomy for ductal cancer of the pancreas,² the total number of lymph node metastases or the ratio of the number of metastatic lymph nodes to the total number of lymph nodes examined was the strongest predictor of survival. In another study³ assessing the accuracy of staging node-negative pancreas cancer, which included 3505 patients who underwent pancreaticoduodenectomy for adenocarcinoma of the pancreas, . . . [Full Text of this Article]

Tetsuji Fujita, MD
tetsu@jg8.so-net.ne.jp
Jikei University of School of Medicine
Tokyo, Japan

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