Division of Surgery, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Karolinska University Hospital, 141 86, Stockholm, Sweden.
Surg Oncol. 2022 May;41:101735. doi: 10.1016/j.suronc.2022.101735. Epub 2022 Mar 2.
Para-aortic lymph node (PALN) metastases in pancreatic ductal adenocarcinoma (PDAC) correlates with poor prognosis. The role of PALN in invasive intraductal papillary mucinous neoplasms (inv-IPMN) has not been well explored. The present study investigated the rate of metastatic PALN, lymph node ratio (LNR) and the overall nodal (N) status as prognostic factors in PDAC and inv-IPMN.
This consecutive single-center series included patients with PDAC or inv-IPMN in the pancreatic head who underwent pancreatoduodenectomy or total pancreatectomy, including PALN resection between 2009 and 2018. Median overall survival (mOS) and impact of clinicopathological factors, including PALN status on survival, were evaluated.
403 patients were included, 314 had PDAC and 89 inv-IPMN. PALN were metastatic in 16% of PDAC and 17% of inv-IPMN. N0 status was present in 6% of the patients with PDAC and 16% of inv-IPMN patients (p = 0.007). LNR >15% was more common in PDAC (52%) than in inv-IPMN (34%) (p = 0.004). mOS was 12.7 months in the presence of PALN metastases and 22.7 months without (p < 0.0001). Age >70 years, CA19-9 >200 U/mL, PDAC and N2 status were significantly associated with worse survival in a multivariable analysis. PALN status and LNR were not independent prognostic factors. In N2 status mOS was similar regardless the presence of PALN metastases.
The frequency of PALN metastases was similar in PDAC and inv-IPMN. Although PALN positive status entailed a shorter mOS, it was not an independent risk factor for death, and did not influence survival in N2-staged disease. The M1-status for PALN positivity may need reconsideration.
在胰腺导管腺癌 (PDAC) 中，腹主动脉旁淋巴结 (PALN) 转移与预后不良相关。PALN 在侵袭性胰管内乳头状黏液性肿瘤 (inv-IPMN) 中的作用尚未得到充分探索。本研究旨在探讨 PDAC 和 inv-IPMN 中 PALN 转移率、淋巴结比率 (LNR) 和总体淋巴结 (N) 状态作为预后因素的作用。
本连续单中心研究纳入了 2009 年至 2018 年间在胰腺头部接受胰十二指肠切除术或全胰切除术的 PDAC 或 inv-IPMN 患者，包括 PALN 切除术。评估了中位总生存期 (mOS) 以及临床病理因素（包括 PALN 状态）对生存的影响。
共纳入 403 例患者，其中 314 例为 PDAC，89 例为 inv-IPMN。PDAC 中 PALN 转移率为 16%，inv-IPMN 为 17%。PDAC 患者中 N0 状态为 6%，inv-IPMN 患者为 16%（p=0.007）。LNR>15%在 PDAC 中更为常见（52%），而在 inv-IPMN 中则较为少见（34%）（p=0.004）。有 PALN 转移的患者 mOS 为 12.7 个月，无 PALN 转移的患者 mOS 为 22.7 个月（p<0.0001）。多变量分析显示，年龄>70 岁、CA19-9>200 U/mL、PDAC 和 N2 状态与生存较差显著相关。PALN 状态和 LNR 不是独立的预后因素。在 N2 状态下，无论是否存在 PALN 转移，mOS 均相似。
PDAC 和 inv-IPMN 中 PALN 转移的频率相似。尽管 PALN 阳性状态预示着较短的 mOS，但它不是死亡的独立危险因素，并且在 N2 期疾病中不影响生存。对于 PALN 阳性的 M1 状态可能需要重新考虑。
