Department of Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
Department of Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
Pancreatology. 2021 Apr;21(3):606-612. doi: 10.1016/j.pan.2021.01.022. Epub 2021 Feb 6.
This study aimed to identify the preoperative risk factors for para-aortic lymph node (PALN) positivity, including micrometastasis, in pancreatic cancer.
Medical records of patients with pancreatic cancer who underwent curative resection were retrospectively reviewed, and the relationships between preoperative risk factors and PALN positivity were identified. Clinicopathological and prognostic factors for overall survival were analyzed. Micrometastasis was investigated by immunohistochemistry.
400 patients were enrolled. PALN positivity by hematoxylin and eosin staining, micrometastasis, and negative were found in 46 (11%), 32 (8%), and 322 (81%) patients, respectively. The median overall survival times of patients with PALN positivity, including micrometastasis, was 22.5 months. Multivariate logistic regression identified borderline or locally advanced status (p=0.037), elevated preoperative carbohydrate antigen (CA) 19-9 level (p<0.001), larger tumor size ≥30 mm (p=0.001) and larger PALN size ≥10 mm (p=0.019) as independent preoperative risk factors of PALN positivity. Multivariate overall survival analysis demonstrated borderline or locally advanced status (p=0.013), elevated preoperative CA19-9 level (p<0.001) and PALN positivity (p=0.048) were independent poor prognostic factors.
Borderline or locally advanced status, elevated preoperative CA19-9 level, and larger tumor and PALN size were risk factors for PALN positivity, and thus, they may contribute to the optimization of preoperative treatments for patients with potential PALN positivity.
本研究旨在确定胰腺癌患者腹主动脉旁淋巴结（PALN）阳性（包括微转移）的术前危险因素。
回顾性分析接受根治性切除术的胰腺癌患者的病历资料，确定术前危险因素与 PALN 阳性之间的关系。分析总生存的临床病理和预后因素。通过免疫组织化学检查微转移。
共纳入 400 例患者。苏木精和伊红染色阳性、微转移和阴性的 PALN 阳性率分别为 46（11%）、32（8%）和 322（81%）。PALN 阳性（包括微转移）患者的中位总生存时间为 22.5 个月。多因素逻辑回归分析确定边界或局部进展状态（p=0.037）、术前糖类抗原（CA）19-9 水平升高（p<0.001）、肿瘤直径较大（≥30mm，p=0.001）和 PALN 直径较大（≥10mm，p=0.019）是 PALN 阳性的独立术前危险因素。多因素总生存分析表明边界或局部进展状态（p=0.013）、术前 CA19-9 水平升高（p<0.001）和 PALN 阳性（p=0.048）是独立的不良预后因素。
边界或局部进展状态、术前 CA19-9 水平升高以及肿瘤和 PALN 直径较大是 PALN 阳性的危险因素，因此，这些因素可能有助于优化潜在 PALN 阳性患者的术前治疗。
