Kwon J, Kim K, Chie E K, Kim B H, Jang J-Y, Kim S W, Oh D-Y, Bang Y-J
Department of Radiation Oncology, Seoul National University College of Medicine, Daehak-ro 101, Jongno-gu, Seoul, South Korea; Department of Radiation Oncology, Chungnam National University Hospital, Munhwaro 282, Jungku, Daejeon, South Korea.
Department of Radiation Oncology, Ewha Womans University School of Medicine, Anyangcheon-ro, Yangcheon-gu, Seoul, South Korea.
Eur J Surg Oncol. 2017 Sep;43(9):1690-1696. doi: 10.1016/j.ejso.2017.05.024. Epub 2017 Jun 15.
Attempts have been made to revise the nodal stage due to simplicity of current N staging system in ampullary adenocarcinoma. However, because of the disease rarity, there have only been a few studies assessing the prognostic impact of lymph node (LN) parameters.
We retrospectively analyzed 120 patients who underwent radical resection followed by adjuvant chemoradiotherapy for ampullary adenocarcinoma. The effect of LN parameters (number of total harvest LNs, number of metastatic LN (MLN), lymph node ratio (LNR), and log odds of positive LNs (LODDS)) on overall survival (OS), locoregional relapse-free survival (LRFS) and distant metastasis-free survival were evaluated. Cutoff points of MLN, LNR and LODDs were determined using maximal χ method.
Fifty-seven patients (48%) were staged as pN1 and their survival was not significantly decreased compared with pN0 patients. There was also no significant difference between patients with MLN 0 vs. 1. In univariate analyses, MLN (0-1 vs. ≥2), LNR (≤17% vs. >17%) and perineural invasion were common prognosticators for OS and LRFS. Distant metastasis-free survival was not influenced by LN status. In addition, multivariate analysis revealed that among the LN parameters, LNR was able to independently predict both OS and LRFS.
LNR performs better than other LN related parameters for predicting survival. After radical resection followed by adjuvant treatment, survival of patients with one positive LN does not seem to differ from patients without LN metastasis.
由于目前壶腹腺癌N分期系统过于简单，人们尝试对其进行修订。然而，由于该疾病较为罕见，仅有少数研究评估了淋巴结（LN）参数对预后的影响。
我们回顾性分析了120例行根治性切除并接受辅助放化疗的壶腹腺癌患者。评估了LN参数（总收获淋巴结数、转移淋巴结数（MLN）、淋巴结比率（LNR）和阳性淋巴结对数优势比（LODDS））对总生存期（OS）、局部区域无复发生存期（LRFS）和远处转移无生存期的影响。使用最大χ²法确定MLN、LNR和LODDS的截断点。
57例患者（48%）被分期为pN1，与pN0患者相比，其生存期无显著降低。MLN为0与1的患者之间也无显著差异。在单因素分析中，MLN（0 - 1 vs.≥2）、LNR（≤17% vs.>17%）和神经周围侵犯是OS和LRFS的常见预后因素。远处转移无生存期不受LN状态影响。此外，多因素分析显示，在LN参数中，LNR能够独立预测OS和LRFS。
在预测生存方面，LNR比其他与LN相关的参数表现更好。根治性切除并接受辅助治疗后，有一个阳性LN的患者的生存期似乎与无LN转移的患者没有差异。
