Liu Zu-Qiang, Xiao Zhi-Wen, Luo Guo-Pei, Liu Liang, Liu Chen, Xu Jin, Long Jiang, Ni Quan-Xing, Yu Xian-Jun
Department of Pancreatic and Hepatobiliary Surgery, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University; Pancreatic Cancer Institute, Fudan University, Shanghai 200032, China.
Hepatobiliary Pancreat Dis Int. 2014 Dec;13(6):634-41. doi: 10.1016/s1499-3872(14)60264-2.
The prognostic factors related to lymph node involvement [lymph node status, the number of positive lymph nodes, lymph node ratio (LNR)] and the number of nodes evaluated in patients with pancreatic adenocarcinoma after pancreatectomy are poorly defined.
A total of 167 patients who had undergone resection of pancreatic adenocarcinoma from February 2010 to August 2011 were included in this study. Histological examination was performed to evaluate the tumor differentiation and lymph node involvement. Univariate and multivariate analyses were made to determine the relationship between the variables related to nodal involvement and the number of nodes and survival.
The median number of total nodes examined was 10 (range 0-44) for the entire cohort. The median number of total nodes examined in node-negative (pN0) patients was similar to that in node-positive (pN1) patients. Patients with pN1 diseases had significantly worse survival than those with pN0 ones (P=0.000). Patients with three or more positive nodes had a poorer prognosis compared with those with the negative nodes (P=0.000). The prognosis of the patients with negative nodes was similar to that of those with one to two positive nodes (P=0.114). The median survival of patients with an LNR ≥0.4 was shorter than that of patients with an LNR <0.4 in the pN1 cohort (P=0.014). No significance was found between the number of total nodes examined and the prognosis, regardless of the cutoff of 10 or 12 and in the entire cohort or the pN0 and pN1 groups. Based on the multivariate analysis of the entire cohort and the pN1 group, the nodal status, the number of positive nodes and the LNR were all associated with survival.
In addition to the nodal status, the number of positive nodes and the LNR can serve as comprehensive factors for the evaluation of nodal involvement. This approach may be more effective for predicting the survival of patients with pancreatic adenocarcinoma after pancreatectomy.
与胰腺腺癌患者胰十二指肠切除术后淋巴结受累相关的预后因素（淋巴结状态、阳性淋巴结数量、淋巴结比率[LNR]）以及评估的淋巴结数量，目前定义尚不明确。
本研究纳入了2010年2月至2011年8月期间接受胰腺腺癌切除术的167例患者。进行组织学检查以评估肿瘤分化和淋巴结受累情况。进行单因素和多因素分析，以确定与淋巴结受累相关的变量、淋巴结数量与生存之间的关系。
整个队列中检查的总淋巴结中位数为10个（范围0 - 44个）。淋巴结阴性（pN0）患者检查的总淋巴结中位数与淋巴结阳性（pN1）患者相似。pN1疾病患者的生存情况明显比pN0患者差（P = 0.000）。有三个或更多阳性淋巴结的患者与阴性淋巴结患者相比预后较差（P = 0.000）。阴性淋巴结患者的预后与一到两个阳性淋巴结患者的预后相似（P = 0.114）。在pN1队列中，LNR≥0.4的患者中位生存期短于LNR < 0.4的患者（P = 0.014）。无论以10或12为界值，在整个队列或pN0和pN1组中，检查的总淋巴结数量与预后之间均未发现显著差异。基于对整个队列和pN1组的多因素分析，淋巴结状态、阳性淋巴结数量和LNR均与生存相关。
除淋巴结状态外，阳性淋巴结数量和LNR可作为评估淋巴结受累的综合因素。这种方法可能对预测胰腺腺癌患者胰十二指肠切除术后的生存更有效。
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