Department of Surgery II, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Pancreas. 2011 Aug;40(6):951-5. doi: 10.1097/MPA.0b013e3182148342.
We aimed to clarify the detailed pattern of lymph node (LN) metastasis spread in patients with pancreatic cancer.
This retrospective study enrolled 429 patients who underwent pancreatectomy with extended lymphadenectomy for pancreatic cancer. The prognostic implications of LN metastasis were evaluated, and the position, frequency, and association with other clinicopathologic factors were investigated.
Lymph node metastasis was confirmed pathologically in 289 patients (67.4%). The prognosis of patients with LN metastasis was significantly poorer than that of patients without LN metastasis (P < 0.001). Distant LN metastasis occurred frequently, regardless of the tumor site. Patients classified with T1 or T2 only had regional LN metastasis, whereas there was a high rate of distant LN metastasis, including the para-aortic LNs, in patients with T3 or higher-stage tumors. Para-aortic LN metastasis was significantly associated with arterial and perineural invasion (P = 0.006 and P < 0.001, respectively). Lymph node metastasis in the hepatic portal region was a strong predictor of para-aortic LN metastasis in pancreatic head cancer.
Pancreatic cancer frequently metastasized to distant LNs via a complex pathway and developed into systemic disease. Aggressive multimodality therapy, including neoadjuvant therapy, is essential to improve the long-term survival of patients at substantial risk of distant LN metastasis.
我们旨在阐明胰腺癌患者淋巴结（LN）转移扩散的详细模式。
本回顾性研究纳入了 429 名接受胰周淋巴结清扫术治疗胰腺癌的患者。评估了 LN 转移的预后意义，并研究了其位置、频率及其与其他临床病理因素的关系。
289 例（67.4%）患者经病理证实存在淋巴结转移。有 LN 转移的患者的预后明显差于无 LN 转移的患者（P<0.001）。无论肿瘤部位如何，远处 LN 转移均较常见。T1 或 T2 期患者仅存在区域性 LN 转移，而 T3 期或更高分期的肿瘤患者远处 LN 转移率较高，包括主动脉旁 LN。主动脉旁 LN 转移与动脉侵犯和神经周围侵犯显著相关（P=0.006 和 P<0.001）。胰头癌肝门区淋巴结转移是主动脉旁淋巴结转移的强烈预测因子。
胰腺癌通过复杂的途径向远处 LN 转移，并发展为全身性疾病。包括新辅助治疗在内的积极多模态治疗对于改善存在远处 LN 转移高风险患者的长期生存至关重要。
