Departments of Surgery, Academic Medical Centre, Amsterdam, The Netherlands.
Br J Surg. 2015 Feb;102(3):237-45. doi: 10.1002/bjs.9709. Epub 2014 Dec 22.
According to some studies, the number of lymph nodes with metastases in relation to the total number of removed lymph nodes, the lymph node ratio (LNR), is one of the most powerful predictors of survival after resection in patients with pancreatic cancer. However, contradictory results have been reported, and small sample sizes of the cohorts and different definitions of a microscopic positive resection margin (R1) hamper the interpretation of data.
The predictive value of LNR for 3-year survival was assessed using a Cox proportional hazards model. From 1992 to 2012, all patients with pancreatic and periampullary cancer operated on with pancreatoduodenectomy were selected from a database. Clinicopathological characteristics were analysed. Microscopic positive resection margin was defined as the microscopic presence of tumour cells within 1 mm of the margins. A nomogram was created.
Some 760 patients were included. Predictive factors for death in 350 patients with pancreatic ductal adenocarcinoma included in the nomogram were: R1 resection (hazard ratio (HR) 1·55, 95 per cent c.i. 1·07 to 2·25), poor tumour differentiation (HR 2·78, 1·40 to 5·52), LNR above 0·18 (HR 1·75, 1·13 to 2·70) and no adjuvant therapy (HR 1·54, 1·01 to 2·34). The C statistic was 0·658 (0·632 to 0·698), and calibration was good (Hosmer-Lemeshow χ(2) = 5·67, P =0·773). LNR and poor tumour differentiation (HR 4·51 and 3·30 respectively) were also predictive in patients with distal common bile duct (CBD) cancer. LNR, R1 resection and jaundice were predictors of death in patients with ampullary cancer (HR 7·82, 2·68 and 1·93 respectively).
LNR is a common predictor of poor survival in pancreatic, distal CBD and ampullary cancer.
根据一些研究，淋巴结转移与切除淋巴结总数的比值（LNR）是预测胰腺癌患者切除术后生存的最有力指标之一。然而，已有研究结果相互矛盾，且队列样本量较小，以及对微小阳性切缘（R1）的不同定义，阻碍了数据的解释。
采用Cox 比例风险模型评估 LNR 对 3 年生存率的预测价值。从 1992 年至 2012 年，从数据库中选择所有接受胰十二指肠切除术治疗的胰腺和壶腹周围癌患者。分析临床病理特征。定义微小阳性切缘为肿瘤细胞在切缘 1mm 内的显微镜下存在。创建了一个列线图。
共纳入 760 例患者。纳入的 350 例胰腺导管腺癌患者死亡的预测因素包括：R1 切除（风险比（HR）1·55，95%可信区间 1·07 至 2·25）、肿瘤分化差（HR 2·78，1·40 至 5·52）、LNR 高于 0·18（HR 1·75，1·13 至 2·70）和未接受辅助治疗（HR 1·54，1·01 至 2·34）。C 统计量为 0·658（0·632 至 0·698），校准良好（Hosmer-Lemeshow χ(2) = 5.67，P = 0.773）。LNR 和肿瘤分化差（HR 分别为 4.51 和 3.30）在远端胆总管（CBD）癌患者中也是预测因素。LNR、R1 切除和黄疸是壶腹癌患者死亡的预测因素（HR 分别为 7.82、2.68 和 1.93）。
LNR 是预测胰腺癌、远端 CBD 癌和壶腹癌患者不良生存的常见指标。
