Fischer Laurice K, Katz Matthew H, Lee Sun M, Liu Li, Wang Hua, Varadhachary Gauri R, Wolff Robert A, Lee Jeffrey E, Maitra Anirban, Roland Christina L, Fleming Jason B, Estrella Jeannelyn, Rashid Asif, Wang Huamin
Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Histopathology. 2016 Jan;68(2):210-20. doi: 10.1111/his.12732. Epub 2015 Jun 19.
This study is to examine the significance of the number and ratio of positive nodes in post-neoadjuvant therapy pancreaticoduodenectomy (PD) for pancreatic ductal adenocarcinoma (PDAC).
Our study population consisted of 398 consecutive PDAC patients, who completed neoadjuvant therapy and PD between 1999 and 2012. Lymph node status was classified as ypN0 (node-negative), ypN1 (1-2 positive nodes) and ypN2 (≥3 positive nodes) and correlated with disease-free survival (DFS) and overall survival (OS). The ypN0, ypN1 and ypN2 was present in 183 (46.0%), 117 (29.4%) and 98 (24.6%) patients, respectively. Additionally, 162 (40.7%) had a lymph node ratio (LNR) ≤0.19 and 53 (13.3%) had a LNR >0.19. Patients with ypN1 disease had shorter DFS and OS than those with ypN0 disease, but better DFS and OS than those with ypN2 disease (P < 0.05). Similarly, patients with a LNR ≤ 0.19 had better DFS and OS than those with a LNR > 0.19 (P < 0.001). In multivariate analysis, both the number of positive nodes and LNR were independent prognostic factors for DFS and OS.
Subclassification of post-therapy node-positive group into ypN1 (1-2 positive nodes) and ypN2 (≥3 positive nodes) should be incorporated into the American Joint Committee on Cancer (AJCC) staging of PDAC patients.
本研究旨在探讨新辅助治疗后胰十二指肠切除术（PD）治疗胰腺导管腺癌（PDAC）时阳性淋巴结数量及比例的意义。
我们的研究对象包括1999年至2012年间连续纳入的398例完成新辅助治疗及PD的PDAC患者。淋巴结状态分为ypN0（无淋巴结转移）、ypN1（1 - 2个阳性淋巴结）和ypN2（≥3个阳性淋巴结），并与无病生存期（DFS）和总生存期（OS）相关联。ypN0、ypN1和ypN2分别见于183例（46.0%）、117例（29.4%）和98例（24.6%）患者。此外，162例（40.7%）患者的淋巴结比率（LNR）≤0.19，53例（13.3%）患者的LNR>0.19。ypN1疾病患者的DFS和OS短于ypN0疾病患者，但优于ypN2疾病患者（P<0.05）。同样，LNR≤0.19的患者的DFS和OS优于LNR>0.19的患者（P<0.001）。多因素分析显示，阳性淋巴结数量和LNR均为DFS和OS的独立预后因素。
治疗后淋巴结阳性组应细分为ypN1（1 - 2个阳性淋巴结）和ypN2（≥3个阳性淋巴结），并纳入美国癌症联合委员会（AJCC）对PDAC患者的分期。
