Department of Gastrointestinal Surgery, The Affiliated Chengdu 363 Hospital of Southwest Medical University, Chengdu, Sichuan, China.
Department of General Surgery, Sichuan Provincial Hospital for Women and Children (Affiliated Women and Children's Hospital of Chengdu Medical College), Chengdu, Sichuan, China.
PLoS One. 2021 Jan 15;16(1):e0244987. doi: 10.1371/journal.pone.0244987. eCollection 2021.
The numbers of retrieved lymph nodes (RLNs) and positive lymph nodes (PLNs) had a significant impact on the survival of patients with ampulla of vater cancer (AVC), but the optimal numbers of the both were controversial.
The cohort study aimed to explore the prognostic value and the optimal point of RLNs and PLNs for AVC.
A total of 2347 AVC patients with M0 disease who underwent surgical resection and lymph node dissection from January 2004 to December 2013 were acquired from a prospective database.
The study found that the optimal cut-off values of RLNs were 18 in the N0 cohort and 16 in N1 or entire cohort due to the highest 5-year overall survival (OS) rate and disease-specific survival (DSS) rate and the separation of survival curves (all P < 0.05). In patients with RLNs ≥ 16, patients with PLN = 0 demonstrated significantly better 5-year OS and DSS rates (70.9% and 77.1%) compared to those with PLNs = 1-2 (41.6% and 44.7%; all P < 0.001), and patients with PLNs = 1-2 demonstrated significantly better 5-year OS and DSS rates (41.6% and 44.7%) compared to those with PLNs ≥ 3 (24.3% and 28.0%; all P < 0.001).
This article recommended that at least 16 lymph nodes will improve the prognosis of AVC patients undergoing surgery. The best cut-off values of PLNs recommended for this study were 0 and 2, which may accurately stratify patients.
在壶腹周围癌（AVC）患者中，淋巴结清扫数目（RLNs）和阳性淋巴结数目（PLNs）对患者的生存有显著影响，但最佳的 RLNs 和 PLNs 数目仍存在争议。
本队列研究旨在探讨 RLNs 和 PLNs 对 AVC 的预后价值和最佳临界点。
本研究从 2004 年 1 月至 2013 年 12 月，获取了在接受手术切除和淋巴结清扫的 M0 期 AVC 患者 2347 例，这些患者的数据来自前瞻性数据库。
本研究发现，在 N0 队列中，最佳 RLNs 截断值为 18，在 N1 或全队列中为 16，因为此时 5 年总生存率（OS）和疾病特异性生存率（DSS）最高，生存曲线分离（均 P < 0.05）。在 RLNs≥16 的患者中，PLN = 0 的患者的 5 年 OS 和 DSS 率（70.9%和 77.1%）明显优于 PLN = 1-2 的患者（41.6%和 44.7%；均 P < 0.001），PLN = 1-2 的患者的 5 年 OS 和 DSS 率（41.6%和 44.7%）也明显优于 PLN≥3 的患者（24.3%和 28.0%；均 P < 0.001）。
本文建议至少清扫 16 枚淋巴结可以改善接受手术的 AVC 患者的预后。本研究推荐的 PLNs 的最佳截断值为 0 和 2，这可能可以更准确地对患者进行分层。
