基于阳性淋巴结数的胰腺癌分期。

Staging of pancreatic cancer based on the number of positive lymph nodes.

机构信息

Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany.

Institute of Medical Biometry and Informatics, Heidelberg University Hospital, Heidelberg, Germany.

出版信息

Br J Surg. 2017 Apr;104(5):608-618. doi: 10.1002/bjs.10472. Epub 2017 Feb 14.

DOI:10.1002/bjs.10472

PMID:28195303

Abstract

BACKGROUND

The International Study Group on Pancreatic Surgery has stated that at least 12 lymph nodes should be evaluated for staging of pancreatic cancer. The aim of this population-based study was to evaluate whether the number of positive lymph nodes refines staging.

METHODS

Patients who underwent pancreatectomy for stage I-II pancreatic cancer between 2004 and 2012 were identified from the Surveillance, Epidemiology, and End Results database. The predictive value of the number of positive lymph nodes for survival was assessed by generalized receiver operating characteristic (ROC) curve analysis and propensity score-adjusted Cox regression analysis.

RESULTS

Some 5036 patients were included, with a median of 18 (i.q.r. 15-24) lymph nodes examined. Positive lymph nodes were found in 3555 patients (70·6 per cent). The median duration of follow-up was 15 (i.q.r. 8-28) months. ROC curve analysis revealed that two positive lymph nodes best discriminated overall survival. Patients with one or two positive lymph nodes (pN1a) and those with three or more positive lymph nodes (pN1b) had an increased risk of overall mortality compared with patients who were node-negative (pN0): hazard ratio (HR) 1·47 (95 per cent c.i. 1·33 to 1·64) and HR 2·01 (1·82 to 2·22) respectively. These findings were confirmed by propensity score-adjusted Cox regression analysis. The 5-year overall survival rates were 39·8 (95 per cent c.i. 36·5 to 43·3) per cent for patients with pN0, 21·0 (18·6 to 23·6) per cent for those with pN1a and 11·4 (9·9 to 13·3) per cent for patients with pN1b disease.

CONCLUSION

The number of positive lymph nodes in the resection specimen is a prognostic factor in patients with pancreatic cancer.

摘要

背景

国际胰腺外科学研究组已经指出，至少应评估 12 个淋巴结以对胰腺癌进行分期。本基于人群的研究旨在评估阳性淋巴结的数量是否可以细化分期。

方法

从监测、流行病学和最终结果数据库中确定了 2004 年至 2012 年间接受胰切除术治疗 I-II 期胰腺癌的患者。通过广义接收者操作特征（ROC）曲线分析和倾向评分调整的 Cox 回归分析，评估阳性淋巴结数量对生存的预测价值。

结果

共纳入 5036 例患者，平均检查 18 个（四分位距 15-24）淋巴结。3555 例患者（70.6%）发现阳性淋巴结。中位随访时间为 15 个月（四分位距 8-28）。ROC 曲线分析显示，两个阳性淋巴结可最佳区分总生存。与淋巴结阴性（pN0）的患者相比，有一个或两个阳性淋巴结（pN1a）和有三个或更多阳性淋巴结（pN1b）的患者总死亡率增加：风险比（HR）为 1.47（95%可信区间 1.33 至 1.64）和 HR 2.01（1.82 至 2.22）。这些发现通过倾向评分调整的 Cox 回归分析得到证实。pN0 患者的 5 年总生存率为 39.8%（95%可信区间 36.5%至 43.3%），pN1a 患者为 21.0%（18.6%至 23.6%），pN1b 患者为 11.4%（9.9%至 13.3%）。