胰管腺癌中主动脉旁淋巴结微转移的预后影响

Prognostic Impact of Para-Aortic Lymph Node Micrometastasis in Pancreatic Ductal Adenocarcinoma.

作者信息

Komo Toshiaki, Murakami Yoshiaki, Kondo Naru, Uemura Kenichiro, Hashimoto Yasushi, Nakagawa Naoya, Urabe Kazuhide, Takahashi Shinya, Sueda Taijiro

机构信息

Department of Surgery, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.

出版信息

Ann Surg Oncol. 2016 Jun;23(6):2019-27. doi: 10.1245/s10434-016-5120-8. Epub 2016 Feb 8.

DOI:10.1245/s10434-016-5120-8

PMID:26856722

Abstract

BACKGROUND

It is still unclear whether micrometastasis of para-aortic lymph nodes (PALNs) in pancreatic ductal adenocarcinoma (PDAC) is tantamount to PALN metastasis detected by hematoxylin and eosin (HE) staining.

METHODS

A total of 242 patients with PDAC who underwent radical pancreatectomy with PALN dissection were eligible for this study. Micrometastasis in PALNs was evaluated by CAM 5.2 immunohistochemistry. The relationship between PALN status and overall survival (OS) was analyzed.

RESULTS

Of the 242 enrolled patients, 25 (10 %) had PALN metastasis detected by HE (PALN HE-positive), and 21 (9 %) had PALN micrometastasis not detected by HE but identified by CAM 5.2 immunohistochemistry. Univariate analysis revealed that patients with PALN micrometastasis (p = .004) and PALN HE positivity (p = .003) had a significantly shorter OS than those without PALN metastasis, whereas no significant difference was observed between the two former groups (p = .874). In multivariate analysis, lack of adjuvant chemotherapy (hazard ratio [HR] 2.43, p < .001), PALN micrometastasis (HR 1.89; p = .046), and PALN HE-positivity (HR 1.89, p = .023) were identified as independent risk factors for poor prognosis. Within a subset of 46 patients with PALN HE-positivity or micrometastasis, lack of adjuvant chemotherapy was independently associated with poor OS (HR 2.58. p = .029).

CONCLUSIONS

The prognosis of patients with PALN micrometastasis was extremely poor as well as HE-positive PALNs. However, postoperative adjuvant chemotherapy may contribute to improving the prognosis of PDAC patients with PALN metastasis.

摘要

背景

胰腺导管腺癌（PDAC）中腹主动脉旁淋巴结（PALN）的微转移是否等同于苏木精-伊红（HE）染色检测到的PALN转移仍不清楚。

方法

共有242例行根治性胰腺切除术并清扫PALN的PDAC患者符合本研究条件。通过CAM 5.2免疫组织化学评估PALN中的微转移。分析PALN状态与总生存期（OS）之间的关系。

结果

在242例入组患者中，25例（10%）经HE检测有PALN转移（PALN HE阳性），21例（9%）经HE未检测到但经CAM 5.2免疫组织化学鉴定有PALN微转移。单因素分析显示，有PALN微转移（p = 0.004）和PALN HE阳性（p = 0.003）的患者OS明显短于无PALN转移的患者，而前两组之间未观察到显著差异（p = 0.874）。多因素分析中，未进行辅助化疗（风险比[HR] 2.43，p < 0.001）、PALN微转移（HR 1.89；p = 0.046）和PALN HE阳性（HR 1.89，p = 0.023）被确定为预后不良的独立危险因素。在46例PALN HE阳性或微转移的患者亚组中，未进行辅助化疗与OS不良独立相关（HR 2.58，p = 0.029）。