Hellan Minia, Sun Can-Lan, Artinyan Avo, Mojica-Manosa Pablo, Bhatia Smita, Ellenhorn Joshua D I, Kim Joseph
Department of General Oncologic Surgery, City of Hope National Medical Center, Duarte, CA 91010, USA.
Pancreas. 2008 Jul;37(1):19-24. doi: 10.1097/MPA.0b013e31816074c9.
The role of lymph node (LN) dissection for pancreatic cancer remains uncertain, and guidelines for a minimum LN number have not been established. We hypothesized that LN number in node-negative (N0) pancreatic cancer influences survival.
The Surveillance, Epidemiology, and End Results database was queried for patients undergoing resection for N0 pancreatic adenocarcinoma between 1988 and 2003. Lymph node number was categorized as 1-10, 11-20, and >20.
In a cohort of 1915 patients, the median LN number was 7 (range 1-57); 1365 (71%) patients had <11 LN. Survival was significantly better in the 11 to 20 compared with the 1-10 group (median, 20 vs 15 months, respectively, P < 0.0001); no difference was observed between the 11-20 and >20 groups (median, 20 vs 23 months, respectively, P = 0.14). Multivariate analysis demonstrated the prognostic significance of LN number for determining overall survival (hazard ratio 0.98, 95% confidence interval: 0.97-0.99; P<0.0001).
Pancreatic cancer lymphadenectomy with examination of >10 LN is associated with improved survival in N0 disease and should be considered a benchmark for adequacy of surgery and/or pathology. Currently, only a minority of patients are assessed by this measure. The variation in LN number may be indicative of diverse surgical technique and/or pathologic analysis and warrants further investigation.
淋巴结清扫术在胰腺癌治疗中的作用仍不明确，且尚未确立清扫淋巴结数量的最低标准。我们推测淋巴结阴性（N0）胰腺癌患者的淋巴结数量会影响生存。
查询监测、流行病学和最终结果数据库，纳入1988年至2003年间接受N0期胰腺腺癌切除术的患者。淋巴结数量分为1 - 10枚、11 - 20枚和>20枚。
在1915例患者队列中，淋巴结数量中位数为7枚（范围1 - 57枚）；1365例（71%）患者的淋巴结数量<11枚。11至20枚组的生存情况显著优于1 - 10枚组（中位数分别为20个月和15个月，P < 0.0001）；11 - 20枚组和>20枚组之间未观察到差异（中位数分别为20个月和23个月，P = 0.14）。多因素分析显示淋巴结数量对确定总生存具有预后意义（风险比0.98，9%置信区间：%0.97 - 0.99；P<0.0001）。
对10枚以上淋巴结进行检查的胰腺癌淋巴结清扫术与N0期疾病患者生存改善相关，应被视为手术和/或病理充分性的基准。目前，只有少数患者接受此标准评估。淋巴结数量的差异可能表明手术技术和/或病理分析存在差异，值得进一步研究。
