Hashimoto Daisuke, Satoi Sohei, Ishida Mitsuaki, Nakagawa Kenji, Kotsuka Masaya, Takagi Tadataka, Ryota Hironori, Terai Taichi, Sakaguchi Tatsuma, Nagai Minako, Yamaki So, Akahori Takahiro, Yamamoto Tomohisa, Sekimoto Mitsugu, Sho Masayuki
Department of Surgery, Kansai Medical University, 2-5-1 Shin-machi, Hirakata-city, Osaka, 573-1010, Japan.
Department of Surgery, Kansai Medical University, 2-5-1 Shin-machi, Hirakata-city, Osaka, 573-1010, Japan.
Pancreatology. 2021 Aug;21(5):884-891. doi: 10.1016/j.pan.2021.03.008. Epub 2021 Mar 19.
Pancreatic ductal adenocarcinoma can directly invade the peripancreatic lymph nodes; however, the significance of direct lymph node invasion is controversial, and it is currently classified as lymph node metastasis. This study aimed to identify the impact of direct invasion of peripancreatic lymph nodes on survival in patients with pancreatic ductal adenocarcinoma.
A total of 411 patients with resectable/borderline resectable pancreatic ductal adenocarcinoma who underwent pancreatic resection at two high-volume centers from 2006 to 2016 were evaluated retrospectively.
Sixty (14.6%) patients had direct invasion of the peripancreatic lymph nodes without isolated lymph node metastasis (N-direct group), 189 (46.0%) had isolated lymph node metastasis (N-met group), and 162 (39.4%) had neither direct invasion nor isolated metastasis (N0 group). There was no significant difference in median overall survival between the N-direct group (35.0 months) and the N0 group (45.6 month) (p = 0.409), but survival was significantly longer in the N-direct compared with the N-met group (25.0 months) (p = 0.003). Similarly, median disease-free survival was similar in the N-direct (21.0 months) and N0 groups (22.7 months) (p = 0.151), but was significantly longer in the N-direct compared with the N-met group (14.0 months) (p < 0.001). Multivariate analysis identified resectability, adjuvant chemotherapy, and isolated lymph node metastasis as independent predictors of overall survival. However, direct lymph node invasion was not a predictor of survival.
Direct invasion of the peripancreatic lymph nodes had no effect on survival in patients undergoing pancreatic resection for pancreatic ductal adenocarcinoma, and should therefore not be classified as lymph node metastasis.
胰腺导管腺癌可直接侵犯胰腺周围淋巴结；然而，直接淋巴结侵犯的意义存在争议，目前被归类为淋巴结转移。本研究旨在确定胰腺周围淋巴结直接侵犯对胰腺导管腺癌患者生存的影响。
回顾性评估了2006年至2016年期间在两个大型中心接受胰腺切除术的411例可切除/临界可切除胰腺导管腺癌患者。
60例（14.6%）患者有胰腺周围淋巴结直接侵犯但无孤立性淋巴结转移（N-直接侵犯组），189例（46.0%）有孤立性淋巴结转移（N-转移组），162例（39.4%）既无直接侵犯也无孤立性转移（N0组）。N-直接侵犯组（35.0个月）和N0组（45.6个月）的中位总生存期无显著差异（p = 0.409），但N-直接侵犯组的生存期明显长于N-转移组（25.0个月）（p = 0.003）。同样，N-直接侵犯组（21.0个月）和N0组（22.7个月）的中位无病生存期相似（p = 0.151），但N-直接侵犯组的无病生存期明显长于N-转移组（14.0个月）（p < 0.001）。多因素分析确定可切除性、辅助化疗和孤立性淋巴结转移是总生存期的独立预测因素。然而，直接淋巴结侵犯不是生存的预测因素。
胰腺周围淋巴结直接侵犯对接受胰腺导管腺癌胰腺切除术的患者生存无影响，因此不应归类为淋巴结转移。
