Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, Shizuoka, Japan.
Division of Diagnostic Radiology, Shizuoka Cancer Center, Shizuoka, Japan.
Ann Surg Oncol. 2021 Apr;28(4):2257-2264. doi: 10.1245/s10434-020-09543-x. Epub 2021 Jan 15.
Lymph node metastasis is one of the strongest prognostic factors of pancreatic cancer. However, the clinical implication of pathologically node-negative pancreatic cancer (pN0-PC) has not been fully investigated.
Patients who underwent surgical resection for radiologically resectable pancreatic cancer between 2002 and 2018 were included in this study. A clinicopathological examination focusing on pN0-PC was performed.
Of all 533 patients, 155 (29.1%) were diagnosed with pN0-PC and 378 (70.9%) were diagnosed with node-positive pancreatic cancer (pN1/2-PC). The 5-year survival rates of patients with pN0-PC and pN1/2-PC were 57.1% and 25.0%, respectively (p < 0.001). A multivariate analysis revealed six prognostic factors in pN0-PC: age ≥ 70 years, nonadministration of adjuvant chemotherapy, anterior serosal invasion, nerve plexus invasion, and microscopic lymphatic and venous invasions. The 5-year survival rates of patients who had pN0-PC with 0-1 risk factor, with 2-3 risk factors, and with 4-6 risk factors were 87.6%, 47.9%, and 16.4%, respectively. Survival of patients who had pN0-PC with 4-6 risk factors was comparable to that of pN1/2 patients. The diagnostic capability of metastasis-negative lymph node was unsatisfactory, with a predictive value of < 43%.
Although the prognosis of patients with pN0-PC was better than that of patients with pN1/2-PC, it is not satisfactory. Survival of patients who had pN0-PC with 0-1 risk factors was extremely favorable; however, survival of patients who had pN0-PC with 4-6 risk factors was similar to those with pN1/2-PC.
淋巴结转移是胰腺癌最强的预后因素之一。然而，病理上淋巴结阴性的胰腺癌（pN0-PC）的临床意义尚未得到充分研究。
本研究纳入了 2002 年至 2018 年间接受放射学可切除胰腺癌手术的患者。对这些患者进行了以 pN0-PC 为重点的临床病理检查。
在所有 533 名患者中，155 名（29.1%）被诊断为 pN0-PC，378 名（70.9%）被诊断为淋巴结阳性胰腺癌（pN1/2-PC）。pN0-PC 和 pN1/2-PC 患者的 5 年生存率分别为 57.1%和 25.0%（p<0.001）。多因素分析显示，pN0-PC 有 6 个预后因素：年龄≥70 岁、未行辅助化疗、前膜侵犯、神经丛侵犯以及镜下淋巴管和静脉侵犯。pN0-PC 患者具有 0-1 个危险因素、2-3 个危险因素和 4-6 个危险因素的 5 年生存率分别为 87.6%、47.9%和 16.4%。具有 4-6 个危险因素的 pN0-PC 患者的生存情况与 pN1/2 患者相当。阴性淋巴结转移的诊断能力不理想，预测值<43%。
尽管 pN0-PC 患者的预后优于 pN1/2-PC 患者，但并不理想。具有 0-1 个危险因素的 pN0-PC 患者的生存情况极好；然而，具有 4-6 个危险因素的 pN0-PC 患者的生存情况与 pN1/2-PC 患者相似。
