Berger Adam C, Watson James C, Ross Eric A, Hoffman John P
Department of Surgical Oncology, Division of Biostatistics, Fox Chase Cancer Center, Philadelphia, Pennsylvania 19111, USA.
Am Surg. 2004 Mar;70(3):235-40; discussion 240.
Survival after curative resection for pancreatic adenocarcinoma remains poor; an important prognostic factor is lymph node (LN) status. Recent reports have established the number of LN examined as a separate prognostic factor in many malignancies. We retrospectively reviewed the charts of 128 patients undergoing pancreaticoduodenectomy (PD) for pancreatic cancer and obtained information such as overall survival (OS), disease-free survival (DFS), tumor characteristics, preoperative carbohydrate antigen (CA) 19-9, sex, and age. The ratio of metastatic to examined LN (LNR) was determined, and OS and DFS were analyzed in relation to the three groups: LNR = 0, LNR < 0.15, and LNR > 0.15. The median number of LN collected was 17. There were 46 N0 patients (median = 12) and 83 N1 patients (median = 19). The number of LN harvested had no impact on OS or DFS in the N0 or N1 patient populations. When LNR was examined as a continuous variable, it had a borderline impact on OS (P = 0.068). Examination of LNR by three groups showed an impact on OS (P = 0.037) and DFS (P = 0.013). After curative PD for pancreatic cancer, the ratio of metastatic to examined lymph nodes is an important prognostic factor and should be evaluated in stratification schemes for future clinical trials investigating adjuvant treatments.
胰腺癌根治性切除术后的生存率仍然很低；一个重要的预后因素是淋巴结（LN）状态。最近的报告已将检查的淋巴结数量确定为许多恶性肿瘤中的一个独立预后因素。我们回顾性分析了128例行胰腺癌胰十二指肠切除术（PD）患者的病历，并获取了总生存期（OS）、无病生存期（DFS）、肿瘤特征、术前糖类抗原（CA）19-9、性别和年龄等信息。确定转移淋巴结与检查淋巴结的比例（LNR），并分析三组患者的OS和DFS：LNR = 0、LNR < 0.15和LNR > 0.15。收集的淋巴结中位数为17个。有46例N0患者（中位数 = 12）和83例N1患者（中位数 = 19）。在N0或N1患者群体中，获取的淋巴结数量对OS或DFS没有影响。当将LNR作为连续变量进行检查时，它对OS有临界影响（P = 0.068）。按三组检查LNR显示对OS（P = 0.037）和DFS（P = 0.013）有影响。胰腺癌根治性PD术后，转移淋巴结与检查淋巴结的比例是一个重要的预后因素，在未来研究辅助治疗的临床试验分层方案中应进行评估。
