Department of General Surgery, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.
Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.
Adv Ther. 2021 Aug;38(8):4258-4270. doi: 10.1007/s12325-021-01819-2. Epub 2021 Jun 26.
Pancreatic ductal adenocarcinoma (PDAC) is one of the most lethal malignancies. Larger tumor size is widely acknowledged to be associated with increased lymph node (LN) metastatic potential. However, the quantitative relationships between tumor size and LN metastasis or survival remain unclear. This study aims to quantify the objective relationship between tumor size and the prevalence of LN metastases across a spectrum primary tumor size.
The Surveillance, Epidemiology, and End Results (SEER) database was used to identify 9958 patients with resected PDAC without distant metastasis. The prevalence of LN metastases, LN ratio (LNR), and N2/N1 ratio were assessed amongst different tumor sizes, and the relationships were displayed by matched curves.
In the enrolled cohort, age, tumor site, grade, American Joint Committee on Cancer (AJCC) 8th node staging, tumor size, chemotherapy, and radiotherapy were identified as significant independent predictors for overall survival (OS) and cancer-specific survival (CSS). For tumors within 1-40 mm in size, the prevalence of node-positive disease is closely modelled using a logarithmic formula [0.249 × ln (size) + 0.452] × 100%. The prevalence plateaued between 70% and 80% beyond 40 mm. The mean LNR increased in a stepwise manner as tumor size increased from 1-5 mm (LNR = 0.024) to 41-45 mm (LNR = 0.177); then, beyond 45 mm, it plateaued near 0.170. N2/N1 ratio gradually increased along with tumor size from 1-5 mm (N2/N1 = 0.286) to 41-45 mm (N2/N1 = 1.016), and when tumor size reached to 41-45 mm or more, the ratio stabilized around 1.000. In addition, significant survival prediction by AJCC N staging was observed when tumors ranging between 16 and 45 mm in size.
Regional LN involvement demonstrated a logarithmic growth with increasing tumor sizes in patients with resected PDAC . The probability of metastasis in each regional LN for resected PDAC with tumors greater than 40 mm in size was near 17.0% and their overall prevalence of LN metastasis was 70-80%. Among which, 50% of patients had an N2 stage. Such prediction may be a potential and promising tool for guiding lymphadenectomy in PDAC surgery.
胰腺导管腺癌（PDAC）是最致命的恶性肿瘤之一。人们普遍认为，肿瘤越大，淋巴结（LN）转移的可能性就越高。然而，肿瘤大小与 LN 转移或生存之间的定量关系仍不清楚。本研究旨在定量评估在一系列原发肿瘤大小范围内，肿瘤大小与 LN 转移发生率之间的客观关系。
本研究使用监测、流行病学和最终结果（SEER）数据库，确定了 9958 例无远处转移的可切除 PDAC 患者。评估了不同肿瘤大小的 LN 转移发生率、LN 比（LNR）和 N2/N1 比，并通过匹配曲线显示了这些关系。
在纳入的队列中，年龄、肿瘤部位、分级、美国癌症联合委员会（AJCC）第 8 版淋巴结分期、肿瘤大小、化疗和放疗被确定为总生存（OS）和癌症特异性生存（CSS）的显著独立预测因素。对于 1-40mm 大小的肿瘤，使用对数公式[0.249×ln（大小）+0.452]×100%可以很好地模拟阳性淋巴结疾病的发生率。超过 40mm 后，阳性淋巴结疾病的发生率在 70%-80%之间趋于平稳。LNR 随着肿瘤大小从 1-5mm（LNR=0.024）逐渐增加到 41-45mm（LNR=0.177），然后超过 45mm 后，LNR 稳定在 0.170 附近。随着肿瘤大小从 1-5mm（N2/N1=0.286）逐渐增加到 41-45mm（N2/N1=1.016），N2/N1 比逐渐增加，当肿瘤大小达到 41-45mm 或更大时，比值稳定在 1.000 左右。此外，在肿瘤大小为 16-45mm 的患者中，AJCC N 分期具有显著的生存预测价值。
在可切除 PDAC 患者中，区域 LN 受累呈对数增长，与肿瘤大小增加相关。对于肿瘤大于 40mm 的患者，每个区域 LN 转移的概率接近 17.0%，总体 LN 转移发生率为 70%-80%。其中，50%的患者为 N2 期。这种预测可能是指导 PDAC 手术中淋巴结清扫的一种有潜力和有前途的工具。
