肝外胆管腺癌的充分淋巴结评估。

Adequate lymph node assessment for extrahepatic bile duct adenocarcinoma.

机构信息

Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA.

出版信息

Ann Surg. 2010 Apr;251(4):675-81. doi: 10.1097/SLA.0b013e3181d3d2b2.

DOI:10.1097/SLA.0b013e3181d3d2b2

PMID:20224368

Abstract

OBJECTIVE

To examine the importance of adequate lymph node sampling in staging of extrahepatic bile duct cancer (EHBDCA).

SUMMARY OF BACKGROUND DATA

The American Joint Committee on Cancer staging manual (sixth edition) states that histologic examination of at least 3 lymph nodes is required for adequate N stage determination for EHBDCA. This recommendation has not been validated; however, there has been no comparative assessment of the proximal versus distal bile duct cancer.

METHODS

A total of 257 patients (144 hilar cholangiocarcinoma [HCCA] and 113 distal bile duct adenocarcinoma [DBDCA]) who underwent curative intent resection (1987-2007) were analyzed; patients with gallbladder cancer were excluded. Final disease staging, including lymph node status and total number of nodes examined (total lymph node count), was obtained from the final pathology report. Differences in disease-specific survival, according to nodal status, were compared using the log-rank test. R1 resections (n = 51) were excluded from this analysis.

RESULTS

Metastasis to regional lymph nodes was noted in 89 patients (34.6%) and was an independent prognostic factor of poor survival (median disease-specific survival N0 vs. N1: 53.5 vs. 19.3 months, P < 0.0001, hazard ratio = 2.1 [95% CI: 1.4-3.2]). The median total lymph node count was 6 (range: 0-42), and was significantly lower for HCCA compared with DBDCA (median = 3 [range: 0-16] vs. 12 [range: 1-42], P < 0.001, respectively). For the entire cohort, patients who underwent R0 resection and were classified as N0, based on total lymph node count <11, had a disease-specific survival that was significantly worse than that of patients classified as N0 based on total lymph node count >or=11 (52.6 +/- 9.8 months vs. not reached, P = 0.008). The estimated optimal total lymph node count for HCCA differed from that of DBDCA (n = 7 vs. n = 11, respectively).

CONCLUSIONS

Adequate lymph nodes assessment of EHBDCA, based on the current AJCC recommendations, results in understaging of these tumors. With respect to the optimal total lymph node count, HCCA, and DBDCA should be considered separately.

摘要

目的

探讨肝外胆管癌（EHBDCA）淋巴结分期中充分淋巴结取样的重要性。

背景资料概要

美国癌症联合委员会分期手册（第六版）规定，对于 EHBDCA 的 N 分期，需要对至少 3 个淋巴结进行组织学检查以确定充分的 N 分期。但是，这一建议尚未得到验证，而且对于近端和远端胆管癌之间，也没有进行过比较评估。

方法

对 1987 年至 2007 年间接受根治性切除术的 257 例患者（144 例肝门部胆管癌[HCCA]和 113 例远端胆管腺癌[DBDCA]）进行了分析；排除了胆囊癌患者。从最终的病理报告中获得最终疾病分期，包括淋巴结状态和检查的总淋巴结数（总淋巴结计数）。采用对数秩检验比较根据淋巴结状态的疾病特异性生存率差异。R1 切除（n = 51）不包括在此分析中。

结果

89 例患者（34.6%）出现区域性淋巴结转移，是生存不良的独立预后因素（无淋巴结转移患者的中位疾病特异性生存 N0 与 N1 分别为 53.5 个月和 19.3 个月，P < 0.0001，风险比=2.1 [95%可信区间：1.4-3.2]）。中位总淋巴结计数为 6（范围：0-42），HCCA 明显低于 DBDCA（中位数=3 [范围：0-16] vs. 12 [范围：1-42]，P < 0.001）。对于整个队列，根据总淋巴结计数<11，行 R0 切除且分类为 N0 的患者，疾病特异性生存率明显差于根据总淋巴结计数≥11 分类为 N0 的患者（52.6 +/- 9.8 个月 vs. 未达到，P = 0.008）。EHBDCA 的估计最佳总淋巴结计数与当前 AJCC 建议不同。