Kim Sung Hyun, Hwang Ho Kyoung, Lee Woo Jung, Kang Chang Moo
Department of Hepatobiliary and Pancreatic Surgery, Yonsei University College of Medicine, Pancreaticobiliary Cancer Clinic, Yonsei Cancer Center, Severance Hospital, Seoul, Korea.
Medicine (Baltimore). 2016 Jun;95(26):e4035. doi: 10.1097/MD.0000000000004035.
In this study, we investigated which N staging system was the most accurate at predicting survival in pancreatic cancer patients.Lymph node (LN) metastasis is known to be one of the important prognostic factors in resected pancreatic cancer. There are several LN evaluation systems to predict oncologic impact.From January 1992 to December 2014, 77 medical records of patients who underwent radical pancreatectomy for left-sided pancreatic cancer were reviewed retrospectively. Clinicopathologic variables including pN stage, total number of retrieved LNs (N-RLN), lymph node ratio (LNR), and absolute number of LN metastases (N-LNmet) were evaluated. Disease-free survival (DFS) and disease-specific survival (DSS) were analyzed according to these 4 LN staging systems.In univariate analysis, pN stage (pN0 vs pN1: 17.5 months vs 7.9 months, P = 0.001), LNR (<0.08 vs ≥0.08: 17.5 months vs 4.4 months, P < 0.001), and N-LNmet (#N = 0 vs #N = 1 vs #N≥2: 17.5 months vs 11.0 months vs 6.4 months, P = 0.002) had a significant effect on DFS, whereas the pN stage (pN0 vs pN1: 35.3 months vs 16.7 months, P = 0.001), LNR (<0.08 vs ≥0.08: 37.1 months vs 15.0 months, P < 0.001), and N-LNmet (#N = 0 vs #N = 1 vs #N≥2: 35.3 months vs 18.4 months vs 16.4 months, P = 0.001) had a significant effect on DSS. In multivariate analysis, N-LNmet (#N≥2) was identified as an independent prognostic factor of oncologic outcome (DFS and DSS: Exp (β) = 2.83, P = 0.001, and Exp (β) = 3.17, P = 0.001, respectively).Absolute number of lymph node metastases predicted oncologic outcome in resected left-sided pancreatic cancer patients.
在本研究中，我们调查了哪种N分期系统在预测胰腺癌患者的生存率方面最为准确。已知淋巴结（LN）转移是切除的胰腺癌重要的预后因素之一。有几种LN评估系统可用于预测肿瘤学影响。
回顾性分析了1992年1月至2014年12月期间77例接受根治性胰腺切除术治疗左侧胰腺癌患者的病历。评估了包括pN分期、获取的淋巴结总数（N-RLN）、淋巴结比率（LNR）和淋巴结转移绝对数（N-LNmet）在内的临床病理变量。根据这4种LN分期系统分析无病生存期（DFS）和疾病特异性生存期（DSS）。
在单因素分析中，pN分期（pN0 vs pN1：17.5个月vs 7.9个月，P = 0.001）、LNR（<0.08 vs≥0.08：17.5个月vs 4.4个月，P<0.001）和N-LNmet（#N = 0 vs #N = 1 vs #N≥2：17.5个月vs 11.0个月vs 6.4个月，P = 0.002）对DFS有显著影响，而pN分期（pN0 vs pN1：35.3个月vs 16.7个月，P = 0.001）、LNR（<0.08 vs≥0.08：37.1个月vs 15.0个月，P<0.001）和N-LNmet（#N = 0 vs #N = 1 vs #N≥2：35.3个月vs 18.4个月vs 16.4个月，P = 0.001）对DSS有显著影响。在多因素分析中，N-LNmet（#N≥2）被确定为肿瘤学结局的独立预后因素（DFS和DSS：Exp(β)= 2.83，P = 0.001，以及Exp(β)= 3.17，P = 0.001）。
淋巴结转移绝对数可预测切除的左侧胰腺癌患者的肿瘤学结局。
