Lee Ho-Kyoung, Yoon Yoo-Seok, Han Ho-Seong, Lee Jun Suh, Na Hee Young, Ahn Soomin, Park Jaewoo, Jung Kwangrok, Jung Jae Hyup, Kim Jaihwan, Hwang Jin-Hyeok, Lee Jong-Chan
Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Korea.
Department of Surgery, Seoul National University Bundang Hospital, Seongnam 13620, Korea.
Cancers (Basel). 2021 Sep 3;13(17):4454. doi: 10.3390/cancers13174454.
Radiologically identified para-aortic lymph node (PALN) metastasis is contraindicated for pancreatic cancer (PC) surgery. There is no clinical consensus for unexpected intraoperative PALN enlargement. To analyze the prognostic role of unexpected PALN enlargement in resectable PC, we retrospectively reviewed data of 1953 PC patients in a single tertiary center. Patients with unexpected intraoperative PALN enlargement (group A1, negative pathology, = 59; group A2, positive pathology, = 13) showed median overall survival (OS) of 24.6 (95% CI: 15.2-33.2) and 13.0 (95% CI: 4.9-19.7) months, respectively. Patients with radiological PALN metastasis without other metastases (group B, = 91) showed median OS of 8.6 months (95% CI: 7.4-11.6). Compared with group A1, groups A2 and B had hazard ratios (HRs) of 2.79 (95% CI, 1.4-5.7) and 2.67 (95% CI: 1.8-4.0), respectively. Compared with group A2, group B had HR of 0.96 (95% CI: 0.5-1.9). Multivariable analysis also showed positive PALN as a negative prognostic factor (HR 2.57, 95% CI: 1.2-5.3), whereas positive regional lymph node did not (HR 1.32 95% CI: 0.8-2.3). Thus, unexpected malignant PALN has a negative prognostic impact comparable to radiological PALN metastasis. This results suggests prompt pathologic evaluation for unexpected PALN enlargements is needed and on-site modification of surgical strategy would be considered.
经放射学检查确定的主动脉旁淋巴结（PALN）转移是胰腺癌（PC）手术的禁忌证。对于术中意外出现的PALN肿大，目前尚无临床共识。为了分析术中意外PALN肿大在可切除性PC中的预后作用，我们回顾性分析了一家三级中心1953例PC患者的数据。术中意外出现PALN肿大的患者（A1组，病理阴性，n = 59；A2组，病理阳性，n = 13）的中位总生存期（OS）分别为24.6个月（95%CI：15.2 - 33.2）和13.0个月（95%CI：4.9 - 19.7）。有放射学PALN转移但无其他转移的患者（B组，n = 91）的中位OS为8.6个月（95%CI：7.4 - 11.6）。与A1组相比，A2组和B组的风险比（HR）分别为2.79（95%CI，1.4 - 5.7）和2.67（95%CI：1.8 - 4.0）。与A2组相比，B组的HR为0.96（95%CI：0.5 - 1.9）。多变量分析也显示阳性PALN是一个不良预后因素（HR 2.57，95%CI：1.2 - 5.3），而阳性区域淋巴结则不是（HR 1.32，95%CI：0.8 - 2.3）。因此，意外的恶性PALN具有与放射学PALN转移相当的不良预后影响。这一结果表明，对于意外的PALN肿大需要进行及时的病理评估，并考虑术中调整手术策略。
