Department of Surgery, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Halsted 614, Baltimore, MD, 21287, USA.
Department of Surgery, NYU Langone Health, New York, NY, USA.
World J Surg. 2022 Mar;46(3):667-677. doi: 10.1007/s00268-021-06410-y. Epub 2022 Jan 7.
Nodal disease is prognostic in pancreatic ductal adenocarcinoma (PDAC); however, optimal number of examined lymph nodes (ELNs) required to accurately stage nodal disease in the current era of neoadjuvant therapy remains unknown. The aim of the study was to evaluate the optimal number of ELNs in patients with neoadjuvantly treated PDAC.
A retrospective study was performed on patients with PDAC undergoing resection following neoadjuvant treatment between 2011 and 2018. Clinicopathological data were extracted and analyzed.
Of 546 patients included, 232 (42.5%) had lymph node metastases. The median recurrence free survival (RFS) was 10.6 months (95% confidence interval: 9.7-11.7) and nodal disease was independently associated with shorter RFS (9.1 vs 11.9 months; p < 0.001). A cutoff of 22 ELNs was identified that stratified patients by RFS. Patients with N1 and N2 disease had similar median RFS (9.1 vs 8.9 months; p = 0.410). On multivariable analysis, ELN of ≥ 22 was found to be significantly associated with longer RFS among patients with N0 disease (14.2 vs. 10.9 months, p = 0.046). However, ELN has no impact on RFS for patients with N1/N2 disease (9.5 vs. 8.4 months, p = 0.190). Adjuvant therapy was associated with RFS only in patients with residual nodal disease.
Lymph node metastases remain prognostic in PDAC patients after neoadjuvant treatment. Among N0 patients, a cutoff of 22 ELN was associated with improved RFS and resulted in optimal nodal staging.
在胰腺导管腺癌（PDAC）中，淋巴结疾病具有预后意义；然而，在新辅助治疗时代，为了准确分期淋巴结疾病，所需的检查淋巴结（ELN）的最佳数量仍不清楚。本研究旨在评估新辅助治疗的 PDAC 患者中最佳的 ELN 数量。
对 2011 年至 2018 年间接受新辅助治疗后行切除术的 PDAC 患者进行回顾性研究。提取并分析临床病理数据。
在 546 例患者中，232 例（42.5%）有淋巴结转移。中位无复发生存期（RFS）为 10.6 个月（95%置信区间：9.7-11.7），淋巴结疾病与较短的 RFS 独立相关（9.1 与 11.9 个月；p<0.001）。确定了 22 个 ELN 的截断值，根据 RFS 将患者分层。N1 和 N2 疾病患者的中位 RFS 相似（9.1 与 8.9 个月；p=0.410）。多变量分析发现，在 N0 疾病患者中，ELN≥22 与较长的 RFS 显著相关（14.2 与 10.9 个月，p=0.046）。然而，ELN 对 N1/N2 疾病患者的 RFS 没有影响（9.5 与 8.4 个月，p=0.190）。辅助治疗仅在有残留淋巴结疾病的患者中与 RFS 相关。
淋巴结转移在新辅助治疗后的 PDAC 患者中仍然具有预后意义。在 N0 患者中，ELN 截断值为 22 与改善的 RFS 相关，并实现了最佳的淋巴结分期。
