Unit of General and Pancreatic Surgery, Department of Surgery and Oncology, University of Verona Hospital Trust, Verona, Italy.
Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
Ann Surg. 2019 Dec;270(6):1138-1146. doi: 10.1097/SLA.0000000000002781.
First, to assess the impact of the number of examined lymph nodes (ELNs) on staging and survival after distal pancreatectomy (DP) for pancreatic adenocarcinoma (PDAC). Second, to identify the minimum number of ELNs (MNELNs) ensuring an accurate detection of nodal involvement. Third, to reappraise the role of lymph node (LN) parameters, including N-status and lymph node ratio (LNR).
In contrast with pancreatoduodenectomy, information on LN staging and the MNELN required in DP is lacking.
Patients undergoing DP for PDAC at 2 academic hospitals from 2000 through 2013 were retrospectively analyzed. The eighth edition of the American Joint Committee on Cancer staging system was used. The MNELN was estimated using the binomial probability law. Survival analyses were performed separately for node-negative and node-positive patients using univariable and multivariable models.
The study population consisted of 240 patients. The median number of ELN was 21, significantly lower in node-negative patients as compared with node-positive patients (18.5 vs 24.0; P = 0.001). The proportion of node-positive patients increased with increasing numbers of ELNs, whereas LNR showed an inverse trend. The estimated MNELN was 20. The number of ELN (≥ or <20) was an independent prognostic factor only in node-negative patients [odds ratio (OR) 3.23 for ELN <20), suggesting a stage migration effect. In node-positive patients, N2-class, but not LNR, was a significant predictor of survival at multivariable analysis (OR 1.68).
The number of ELN affects nodal staging in body/tail PDAC. At least 20 LNs are required for correct staging. N-status is superior to LNR in predicting survival of node-positive patients.
首先，评估在胰体尾切除术（DP）治疗胰腺腺癌（PDAC）后，检查的淋巴结（ELNs）数量对分期和生存的影响。其次，确定确保准确检测淋巴结受累所需的最小 ELN 数量（MNELN）。第三，重新评估淋巴结（LN）参数的作用，包括 N 状态和淋巴结比率（LNR）。
与胰十二指肠切除术相比，DP 中 LN 分期和所需的 MNELN 信息缺乏。
回顾性分析了 2000 年至 2013 年在 2 所学术医院接受 DP 治疗的 PDAC 患者。使用第八版美国癌症联合委员会分期系统。使用二项概率定律估计 MNELN。使用单变量和多变量模型分别对淋巴结阴性和淋巴结阳性患者进行生存分析。
研究人群包括 240 名患者。ELN 的中位数为 21，淋巴结阴性患者明显低于淋巴结阳性患者（18.5 与 24.0；P=0.001）。淋巴结阳性患者的比例随 ELN 数量的增加而增加，而 LNR 呈相反趋势。估计的 MNELN 为 20。ELN 数量（≥或<20）仅在淋巴结阴性患者中是独立的预后因素（ELN<20 的优势比[OR]为 3.23），提示存在分期迁移效应。在淋巴结阳性患者中，N2 期而不是 LNR 是多变量分析中生存的显著预测因素（OR 1.68）。
ELN 数量影响体尾部 PDAC 的淋巴结分期。至少需要 20 个 LN 进行正确分期。N 状态比 LNR 更能预测淋巴结阳性患者的生存。
