Division of Cancer Medicine, Department of Gastroenterological Surgery, Graduate School of Medicine, Kanazawa University, Kanazawa, Japan.
Pancreas. 2010 Aug;39(6):884-8. doi: 10.1097/MPA.0b013e3181ce6daa.
The clinical significance of micrometastasis to regional lymph nodes for pancreas cancer is controversial in patients who underwent curative resection.
Nine of 42 patients who underwent macroscopically curative resection of pancreatic head cancer were found to have pN(-) by routine examination. Complete serial section examination of the resected specimens was done to detect micrometastasis in these 9 patients.
A total of 16,505 sections were examined by immunohistochemistry or hematoxylin and eosin staining. Micrometastases were identified in 7 (78%) of 9 patients and 17 (3.6%) of 474 lymph nodes. All micrometastases were found in the pancreas head area. However, the frequency of micrometastases around the superior mesenteric artery was 44%. There were no micrometastases to the para-aortic nodes. There was a tendency that the patients with micrometastases showed better survival than those with overt nodal involvement (P = 0.053). Micrometastasis did not provide the poor prognostic factor in patients who underwent optimal regional lymphadenectomy.
Even in overtly pN(-) pancreatic cancer, micrometastases occur high frequently (78%) and widely, including the nodes around the superior mesenteric artery. These results provide important pathological information when we consider the preoperative, perioperative, and postoperative strategies, even when patients seem to have no nodal involvement by preoperative examinations.
对于接受根治性切除术的胰腺癌患者，区域淋巴结微转移的临床意义仍存在争议。
在 42 例行胰头癌根治性切除术的患者中，有 9 例患者常规检查发现 pN(-)。对这 9 例患者的切除标本进行了完整的连续切片检查，以检测微转移。
通过免疫组化或苏木精-伊红染色共检查了 16505 个切片。在 9 例患者中的 7 例（78%）和 474 个淋巴结中的 17 个（3.6%）发现了微转移。所有微转移均位于胰头部。然而，肠系膜上动脉周围的微转移频率为 44%。无腹主动脉旁淋巴结转移。有微转移的患者的生存情况优于有明显淋巴结受累的患者（P = 0.053）。微转移并未成为接受最佳区域淋巴结清扫术患者的不良预后因素。
即使在明显的 pN(-)胰腺癌中，微转移也很常见（78%）且广泛存在，包括肠系膜上动脉周围的淋巴结。这些结果为我们考虑术前、围手术期和术后策略提供了重要的病理信息，即使患者在术前检查中似乎没有淋巴结受累。
