Zheng Zhen-Jiang, Wang Mo-Jin, Tan Chun-Lu, Chen Yong-Hua, Ping Jie, Liu Xu-Bao
Department of Pancreatic Surgery.
Department of Gastrointestinal Surgery, Institute of Digestive Surgery and State key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.
Medicine (Baltimore). 2020 Feb;99(8):e19327. doi: 10.1097/MD.0000000000019327.
The optimal number of examined lymph nodes (ELN) for staging and impact of nodal status on survival following total pancreatectomy (TP) for pancreatic ductal adenocarcinoma (PDAC) is unclear. The aim of this study was to evaluate the prognostic impact of different lymph node status after TP for PDAC.The Surveillance, Epidemiology, and End Results (SEER) database was used to identify patients who underwent TP for PDAC from 2004 to 2015. We calculated overall survival (OS) of these patients using Kaplan-Meier analysis and Cox proportional hazards model.Overall, 1291 patients were included in the study, with 869 node-positive patients (49.5%). A cut-off points analysis revealed that 19, 19, and 13 lymph nodes best discriminated OS for all patients, node-negative patients, and node-positive patients, respectively. Higher number of ELN than the corresponding cut-off points was an independent predictor for better prognosis [all patients: hazard ratios (HR) 0.786, P = .002; node-negative patients: HR 0.714, P = .043; node-positive patients: HR 0.678, P < .001]. For node-positive patients, 1 to 3 positive lymph nodes (PLN) correlated independently with better survival compared with those with 4 or more PLN (HR 1.433, P = .002). Moreover, when analyzed in node-positive patients with less than 13 ELN, neither the number of PLN nor lymph node ratio (LNR) was associated with survival. However, when limited node-positive patients with at least 13 ELN, univariate analyses showed that both the number of PLN and LNR were associated with survival, whereas multivariate analyses demonstrated that only number of PLN was consistently associated with survival (HR 1.556, P = .004).Evaluation at least 19 lymph nodes should be considered as quality metric of surgery in patients who underwent TP for PDAC. For node-negative patients, a minimal number of 19 lymph nodes is adequate to avoid stage migration. For node-positive patients, PLN is superior to LNR in predicting survival after TP, predominantly for those with high number of ELN.
对于胰腺导管腺癌（PDAC）行全胰切除术（TP）后，用于分期的检查淋巴结最佳数量（ELN）以及淋巴结状态对生存的影响尚不清楚。本研究的目的是评估PDAC行TP后不同淋巴结状态的预后影响。利用监测、流行病学和最终结果（SEER）数据库识别2004年至2015年期间接受PDAC的TP治疗的患者。我们使用Kaplan-Meier分析和Cox比例风险模型计算这些患者的总生存期（OS）。
总体而言，1291例患者纳入本研究，其中869例为淋巴结阳性患者（49.5%）。切点分析显示，19个、19个和13个淋巴结分别对所有患者、淋巴结阴性患者和淋巴结阳性患者的OS具有最佳区分能力。ELN数量高于相应切点是预后较好的独立预测因素[所有患者：风险比（HR）0.786，P = 0.002；淋巴结阴性患者：HR 0.714，P = 0.043；淋巴结阳性患者：HR 0.678，P < 0.001]。对于淋巴结阳性患者，与有4个或更多阳性淋巴结（PLN）的患者相比，1至3个PLN与更好的生存独立相关（HR 1.433，P = 0.002）。此外，在ELN少于13个的淋巴结阳性患者中进行分析时，PLN数量和淋巴结比率（LNR）均与生存无关。然而，当限于ELN至少13个的淋巴结阳性患者时，单因素分析显示PLN数量和LNR均与生存相关，而多因素分析表明只有PLN数量始终与生存相关（HR 1.556，P = 0.004）。
对于接受PDAC的TP治疗的患者，应将至少检查19个淋巴结视为手术质量指标。对于淋巴结阴性患者，最少19个淋巴结足以避免分期偏移。对于淋巴结阳性患者，PLN在预测TP后的生存方面优于LNR，主要是对于ELN数量较多的患者。
