Department of Hepatobiliary Surgery and Institute of Advanced Surgical Technology and Engineering, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH.
Ann Surg. 2021 Jul 1;274(1):e28-e35. doi: 10.1097/SLA.0000000000003478.
To determine the prognostic role of metastatic lymph node (LN) number and the minimal number of LNs for optimal staging of patients with pancreatic neuroendocrine tumors (pNETs).
Prognosis relative to number of LN metastasis (LNM), and minimal number of LNs needed to evaluate for accurate staging, have been poorly defined for pNETs.
Number of LNM and total number of LN evaluated (TNLE) were assessed relative to recurrence-free survival (RFS) and overall survival (OS) in a multi-institutional database. External validation was performed using Surveillance, Epidemiology and End Results (SEER) registry.
Among 854 patients who underwent resection, 233 (27.3%) had at least 1 LNM. Patients with 1, 2, or 3 LNM had a comparable worse RFS versus patients with no nodal metastasis (5-year RFS, 1 LNM 65.6%, 2 LNM 68.2%, 3 LNM 63.2% vs 0 LNM 82.6%; all P < 0.001). In contrast, patients with ≥4 LNM (proposed N2) had a worse RFS versus patients who either had 1 to 3 LNM (proposed N1) or node-negative disease (5-year RFS, ≥4 LNM 43.5% vs 1-3 LNM 66.3%, 0 LNM 82.6%; all P < 0.05) [C-statistics area under the curve (AUC) 0.650]. TNLE ≥8 had the highest discriminatory power relative to RFS (AUC 0.713) and OS (AUC 0.726) among patients who had 1 to 3 LNM, and patients who had ≥4 LNM in the multi-institutional and SEER database (n = 2764).
Regional lymphadenectomy of at least 8 lymph nodes was necessary to stage patients accurately. The proposed nodal staging of N0, N1, and N2 optimally staged patients.
确定转移性淋巴结 (LN) 数量和评估最小 LN 数量对胰腺神经内分泌肿瘤 (pNET) 患者进行最佳分期的预后作用。
对于 pNET 患者，LN 转移 (LNM) 数量和评估所需的最小 LN 数量与预后的相关性尚未明确。
在多机构数据库中，评估 LNM 数量和总 LN 评估数量 (TNLE) 与无复发生存率 (RFS) 和总生存率 (OS) 的关系。使用监测、流行病学和最终结果 (SEER) 登记处进行外部验证。
在接受切除术的 854 名患者中，有 233 名 (27.3%) 至少有 1 个 LNM。与无淋巴结转移的患者相比，有 1、2 或 3 个 LNM 的患者的 RFS 更差 (5 年 RFS，1 个 LNM 为 65.6%，2 个 LNM 为 68.2%，3 个 LNM 为 63.2%，而 0 个 LNM 为 82.6%；均 P < 0.001)。相比之下，有≥4 个 LNM (拟诊 N2) 的患者的 RFS 更差，与有 1 至 3 个 LNM (拟诊 N1) 或无淋巴结疾病的患者相比 (5 年 RFS，≥4 个 LNM 为 43.5%，1-3 个 LNM 为 66.3%，0 个 LNM 为 82.6%；均 P < 0.05)[C 统计量曲线下面积 (AUC) 为 0.650]。在多机构和 SEER 数据库 (n = 2764) 中，有 1 至 3 个 LNM 的患者，以及有≥4 个 LNM 的患者，TNLE≥8 与 RFS(AUC 为 0.713)和 OS(AUC 为 0.726) 相比具有最高的区分能力。
至少进行 8 个淋巴结的区域淋巴结切除术对于准确分期患者是必要的。N0、N1 和 N2 的拟议淋巴结分期可使患者得到最佳分期。
