Saluja Sundeep Singh, Mishra Pramod Kumar, Kiran Shashi, Shah Harsh J, Chandrasekar Sandip, Nayeem Mohammed, Sharma Aditya, Varshney Vaibhav Kumar
Department of Gastrointestinal Surgery, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research, New Delhi, India.
Ann Hepatobiliary Pancreat Surg. 2020 Nov 30;24(4):484-495. doi: 10.14701/ahbps.2020.24.4.484.
BACKGROUNDS/AIMS: Lymph node (LN) metastasis though, is a poor prognostic factor for ampullary carcinoma (APC), the impact of Lymph node ratio (LNR) and Logarithm odds of positive lymph node (LODDS) in the long-term survival remains controversial. We evaluated the factors affecting the long-term outcome in APC patients with emphasis on LNR and LODDS.
The prospectively collected data of 198 patients who underwent pancreatoduodenectomy for APC was analyzed after excluding 12 patients for various reasons. Factors affecting Disease specific survival (DSS) and Recurrence free survival (RFS) were analyzed with special reference to LN positivity, LNR and LODDS.
Out of 186, 117 (62.9%) patients were alive at a median follow-up of 39.5 months and 72 (38.7%) developed recurrence. The overall 5-year DSS was 59.3% & RFS 54.9%. Univariate analysis showed T-stage, tumor differentiation, perineural invasion, LN positivity, LNR and LODDS was significantly affected DSS and RFS. On multivariate analysis, perineural invasion, LN positivity, LNR and LODDS lost its significance for DSS and RFS. AUC for prediction of DSS and RFS for LNR was 0.654 (<0.001) & 0.629 (=0.003) respectively and for LODDS, it was 0.697 (<0.001) & 0.677 (=0.001) respectively. Sensitivity and specificity of LNR (0.1) for DSS were 37.7% & 83.8% and for RFS were 36.1% & 83.3%; for LODDS (-1.00), sensitivity and specificity for DSS was 62.3% and 67.5% and for RFS it was 59.7% and 66.7% respectively.
LNR and LODDS although independently seem to affect the RFS and DSS, albeit have a low sensitivity and specificity in predicting DSS and RFS.
背景/目的：尽管淋巴结转移是壶腹癌（APC）的一个不良预后因素，但淋巴结比率（LNR）和阳性淋巴结对数优势比（LODDS）对长期生存的影响仍存在争议。我们评估了影响APC患者长期预后的因素，重点关注LNR和LODDS。
在排除12例因各种原因未纳入研究的患者后，对前瞻性收集的198例行胰十二指肠切除术治疗APC患者的数据进行分析。特别参考淋巴结阳性、LNR和LODDS，分析影响疾病特异性生存（DSS）和无复发生存（RFS）的因素。
186例患者中，中位随访39.5个月时，117例（62.9%）存活，72例（38.7%）出现复发。总体5年DSS为59.3%，RFS为54.9%。单因素分析显示，T分期、肿瘤分化、神经周围侵犯、淋巴结阳性、LNR和LODDS对DSS和RFS有显著影响。多因素分析显示，神经周围侵犯、淋巴结阳性、LNR和LODDS对DSS和RFS失去显著性。LNR预测DSS和RFS的AUC分别为0.654（<0.001）和0.629（=0.003），LODDS预测DSS和RFS的AUC分别为0.697（<0.001）和0.677（=0.001）。LNR（0.1）预测DSS的敏感性和特异性分别为37.7%和83.8%，预测RFS的敏感性和特异性分别为36.1%和83.3%；LODDS（-1.00）预测DSS的敏感性和特异性分别为62.3%和67.5%，预测RFS的敏感性和特异性分别为59.7%和66.7%。
LNR和LODDS虽然独立地似乎影响RFS和DSS，但在预测DSS和RFS方面敏感性和特异性较低。
