Division of Surgery, School of Graduate Entry Medicine and Health, University of Nottingham Medical School at Derby, Derby City General Hospital, Uttoxeter Road, Derby, DE22 3DT, UK.
World J Surg. 2010 Apr;34(4):768-75. doi: 10.1007/s00268-009-0336-4.
The objective of this study was to compare the prognostic significance of the lymph node ratio (LNR) with the absolute number of affected lymph nodes for resected pancreatic ductal adenocarcinoma.
Data were collected from 84 patients who had undergone pancreatoduodenectomy for pancreatic ductal adenocarcinoma over a 10-year period. Patients were categorized into four groups according to the absolute LNR (0, 0-0.199, 0.2-0.299, > or =0.3). Kaplan-Meier and Cox proportional hazard models were used to evaluate the prognostic effect.
An LNR of > or =0.2 (median survival 8.1 vs. 35.7 months with LNR < 0.2; p < 0.001) and > or =0.3 (median survival 5.9 vs. 29.6 months with LNR < 0.3; p < 0.001), tumor size (p < 0.017), positive resection margin (p < 0.001), and nodal involvement (p < 0.001) were found to be significant prognostic markers following univariate analysis. Following multivariate analysis, only LNR at both levels [> or =0.2 (p = 0.05; HR 1.8) and LNR of > or =0.3 (p = 0.01; HR 2.7)] were independent predictors of a poor outcome. The number of lymph nodes examined had no effect on overall survival in either node-positive patients (p = 0.339) or node-negative patients (p = 0.473).
The LNR represents a stronger independent prognostic indicator than the absolute number of affected lymph nodes in patients with resected pancreatic ductal adenocarcinoma.
本研究旨在比较淋巴结比率（LNR）与切除的胰腺导管腺癌受累淋巴结绝对数量的预后意义。
收集了 84 例在过去 10 年中因胰腺导管腺癌接受胰十二指肠切除术的患者的数据。根据绝对 LNR（0、0-0.199、0.2-0.299、≥0.3）将患者分为四组。采用 Kaplan-Meier 和 Cox 比例风险模型评估预后效果。
LNR≥0.2（中位生存期 8.1 个月与 LNR<0.2 相比；p<0.001）和 LNR≥0.3（中位生存期 5.9 个月与 LNR<0.3 相比；p<0.001）、肿瘤大小（p<0.017）、阳性切缘（p<0.001）和淋巴结受累（p<0.001）在单因素分析中被发现是显著的预后标志物。多因素分析后，仅 LNR 在两个水平[≥0.2（p=0.05；HR 1.8）和 LNR≥0.3（p=0.01；HR 2.7）]是不良预后的独立预测因子。检查的淋巴结数量对阳性淋巴结患者（p=0.339）或阴性淋巴结患者（p=0.473）的总生存期均无影响。
LNR 是切除的胰腺导管腺癌患者比受累淋巴结绝对数量更强的独立预后指标。
