胰头十二指肠切除术治疗胰腺腺癌时的检查淋巴结数量和淋巴结状态评估。

Number of examined lymph nodes and nodal status assessment in pancreaticoduodenectomy for pancreatic adenocarcinoma.

机构信息

Department of Digestive Surgery, UPMC University Pierre et Marie Curie, Paris VI, Hôpital Saint Antoine, 184 rue du faubourg Saint Antoine, 75012 Paris, France.

出版信息

Eur J Surg Oncol. 2013 Oct;39(10):1116-21. doi: 10.1016/j.ejso.2013.07.089. Epub 2013 Aug 12.

DOI:10.1016/j.ejso.2013.07.089

PMID:23948704

Abstract

BACKGROUND

The accuracy of the assessment of the nodal status in resected cephalic pancreatic adenocarcinoma (PA) depends on the number of examined lymph nodes (NELN). This study assesses the impact of the NELN on N staging and survival and propose a minimal number of examined lymph nodes (MNELN) ensuring reliability of the pN status determination.

METHODS

188 consecutive patients treated by pancreaticoduodenectomy (PD) for PA. Correlations between NELN and survivals of pN0 and pN1 groups and with the rate of pN1 patients were studied. A probability model based on the binomial law was built to estimate the MNELN able to detect pN1 patients with a sensitivity ≥ 95%.

RESULTS

Overall and disease free 5-year survivals were 27.2% and 24.6% respectively. 135 patients (71.8%) were staged pN1. The median NELN was 17 (range 0-68). Overall and disease free survivals of pN1 patients were not related to NELN. The influence of NELN on survival in pN0 patients due to stage migration did not reach significance. The probability model showed that a MNELN of 16 nodes was required to detect pN1 patients with a sensitivity of 95%.

CONCLUSION

A MNELN of 16 is required to assess pN status and should be considered as a quality criterion in future studies and trials on PD for PA.

摘要

背景

切除性头侧胰腺腺癌 (PA) 淋巴结状态的评估准确性取决于检查的淋巴结数量 (NELN)。本研究评估了 NELN 对 N 分期和生存的影响，并提出了保证 pN 状态确定可靠性的最小检查淋巴结数量 (MNELN)。

方法

对 188 例接受胰十二指肠切除术 (PD) 治疗的 PA 患者进行连续研究。研究了 NELN 与 pN0 和 pN1 组生存之间的相关性，以及与 pN1 患者比例的相关性。基于二项式定律构建了一个概率模型，用于估计能够以≥95%的灵敏度检测到 pN1 患者的 MNELN。

结果

总体和无病 5 年生存率分别为 27.2%和 24.6%。135 例患者（71.8%）分期为 pN1。NELN 的中位数为 17（范围 0-68）。pN1 患者的总体和无病生存率与 NELN 无关。由于分期迁移，NELN 对 pN0 患者生存的影响未达到显著性。概率模型显示，需要 16 个 MNELN 才能以 95%的灵敏度检测到 pN1 患者。