Department of Surgery, National Defense Medical College Hospital, Tokorozawa, Saitama, Japan.
Department of Gastrointestinal Surgery, Cancer Institute Hospital, Koto, Tokyo, Japan.
J Hepatobiliary Pancreat Sci. 2020 Oct;27(10):712-720. doi: 10.1002/jhbp.791. Epub 2020 Jul 30.
The TNM (Tumor, Node, Metastasis) classification of the 8th Union for International Cancer Control and the 6th Japanese classification of biliary tract cancer were made on the premise that the prognostic effect of each regional lymph node station is similar. However, some studies have reported different effects of lymph node metastasis location on post-resection prognosis. This study aimed to investigate outcome following radical resection of ampullary carcinoma according to station of lymph node metastasis.
Patients who underwent surgical resection for ampullary carcinoma between January 2007 and December 2017 at two separate Japanese institutions were included. Regional lymph nodes were subclassified as follows: Pancreatoduodenal lymph nodes (PD) and others (OT).
Of the 101 patients analyzed, 34 had regional lymph node metastasis. OT metastasis was found in eight patients. Significant differences were found in relapse-free survival (RFS) and overall survival (OS) between the three study groups (no nodal metastasis, only PD metastasis and OT metastasis; P < .001 for both). OT metastasis was an independent prognostic factor in the multivariate analysis for RFS (hazard ratio [HR] 17.14; 95% confidence interval [CI], 6.33-43.93) and OS (HR 11.06; 95% CI, 3.7-32.99).
The poor prognosis of ampullary carcinoma patients with OT metastasis suggests that regional lymph nodes should not be categorized equally into one group.
第 8 届国际癌症控制联盟（UICC）和第 6 届日本胆道癌分类法（JBCLC）的 TNM（肿瘤、淋巴结、转移）分类是基于每个区域淋巴结站的预后效果相似的前提下制定的。然而，一些研究报告称淋巴结转移位置对术后预后有不同的影响。本研究旨在根据淋巴结转移部位探讨根治性切除壶腹癌的预后。
纳入 2007 年 1 月至 2017 年 12 月在两家日本机构接受手术切除壶腹癌的患者。将区域淋巴结分为胰十二指肠淋巴结（PD）和其他部位（OT）。
在 101 例分析患者中，有 34 例发生区域淋巴结转移。8 例患者发生 OT 转移。在无淋巴结转移、仅 PD 转移和 OT 转移三组研究中，无复发生存率（RFS）和总生存率（OS）差异均有统计学意义（均 P<.001）。OT 转移是 RFS（风险比 [HR] 17.14；95%置信区间 [CI]，6.33-43.93）和 OS（HR 11.06；95%CI，3.7-32.99）多因素分析中的独立预后因素。
OT 转移的壶腹癌患者预后较差，提示区域淋巴结不应归为一类。
