N0/N1、PNL 还是 LNR？淋巴结数量对胰腺导管腺癌准确生存预测的影响。
N0/N1, PNL, or LNR? The effect of lymph node number on accurate survival prediction in pancreatic ductal adenocarcinoma.
机构信息
Department of Surgery and Andrew L. Warshaw, M.D., Institute for Pancreatic Cancer Research, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
出版信息
J Gastrointest Surg. 2013 Feb;17(2):257-66. doi: 10.1007/s11605-012-1974-7. Epub 2012 Dec 11.
INTRODUCTION
We evaluated the prognostic accuracy of LN variables (N0/N1), numbers of positive lymph nodes (PLN), and lymph node ratio (LNR) in the context of the total number of examined lymph nodes (ELN).
METHODS
Patients from SEER and a single institution (MGH) were reviewed and survival analyses performed in subgroups based on numbers of ELN to calculate excess risk of death (hazard ratio, HR).
RESULTS
In SEER and MGH, higher numbers of ELN improved the overall survival for N0 patients. The prognostic significance (N0/N1) and PLN were too variable as the importance of a single PLN depended on the total number of LN dissected. LNR consistently correlated with survival once a certain number of lymph nodes were dissected (≥13 in SEER and ≥17 in the MGH dataset).
CONCLUSIONS
Better survival for N0 patients with increasing ELN likely represents improved staging. PLN have some predictive value but the ELN strongly influence their impact on survival, suggesting the need for a ratio-based classification. LNR strongly correlates with outcome provided that a certain number of lymph nodes is evaluated, suggesting that the prognostic accuracy of any LN variable depends on the total number of ELN.
简介
我们评估了 LN 变量（N0/N1）、阳性淋巴结数量（PLN）和淋巴结比值（LNR）在检查淋巴结总数（ELN）背景下的预后准确性。
方法
对 SEER 和单机构（MGH）的患者进行了回顾，并根据 ELN 的数量进行了亚组生存分析，以计算死亡风险的超额（风险比，HR）。
结果
在 SEER 和 MGH 中，更多的 ELN 改善了 N0 患者的总体生存率。N0/N1 和 PLN 的预后意义变化较大，因为单个 PLN 的重要性取决于切除的 LN 总数。一旦切除了一定数量的淋巴结（SEER 中≥13 个，MGH 数据集≥17 个），LNR 就与生存情况一致相关。
结论
ELN 增加的 N0 患者生存率更好，可能代表了分期的改善。PLN 具有一定的预测价值，但 ELN 强烈影响其对生存的影响，表明需要基于比率的分类。只要评估了一定数量的淋巴结，LNR 就与预后强烈相关，这表明任何 LN 变量的预后准确性都取决于 ELN 的总数。
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