Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Department of Pathology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
J Hepatobiliary Pancreat Sci. 2024 Aug;31(8):569-580. doi: 10.1002/jhbp.12008. Epub 2024 Jun 14.
BACKGROUND/PURPOSE: Extranodal extension (ENE) is an established prognostic factor in various malignancies, affecting survival in pancreatic head cancer (PHC). However, its significance in pancreatic body/tail cancer (PBTC) remains unclear. Therefore, we aimed to investigate the impact of ENE on PTBC prognosis.
We analyzed data collected from electronic medical records of patients with PBTC who underwent distal pancreatectomy at a single center between January 2011 and December 2015. The patients were categorized based on ENE presence and prognostic implications were evaluated using Kaplan-Meier survival curves and Cox proportional hazards model.
PBTC cases involving lymph node (LN) metastasis and ENE exhibited significantly lower disease-free (DFS) and overall survival (OS) rates compared to cases without LN metastasis or ENE (median DFS; N0, 23 months; LN+/ENE-, 10 months; LN+/ENE+, 5 months; p < .001). No statistically significant difference was observed in DFS and OS rates between patients with N1/N2 in the group without ENE and those with ENE+. Multivariate analysis confirmed ENE as a significant adverse prognostic factor.
ENE significantly predicts poor prognosis in PBTC, particularly in cases with nodal metastasis. The current cancer staging system for PBTC should incorporate ENE status. Moreover, different staging systems should be considered for PHC and PBTC.
背景/目的：外膜侵犯（ENE）是各种恶性肿瘤的一种既定预后因素，影响着胰头癌（PHC）的生存率。然而，其在胰体/尾癌（PBTC）中的意义尚不清楚。因此，我们旨在研究 ENE 对 PBTC 预后的影响。
我们分析了 2011 年 1 月至 2015 年 12 月期间在一家单中心接受胰体尾切除术的 PBTC 患者的电子病历数据。根据 ENE 的存在对患者进行分类，并使用 Kaplan-Meier 生存曲线和 Cox 比例风险模型评估预后意义。
与无淋巴结转移或无 ENE 的病例相比，涉及淋巴结（LN）转移和 ENE 的 PBTC 病例的无病生存率（DFS）和总生存率（OS）显著降低（中位 DFS；N0，23 个月；LN+/ENE-，10 个月；LN+/ENE+，5 个月；p<0.001）。在无 ENE 的组中，无 N1/N2 与有 ENE+的患者之间的 DFS 和 OS 率没有统计学差异。多因素分析证实 ENE 是一个显著的不良预后因素。
ENE 显著预测 PBTC 的不良预后，特别是在有淋巴结转移的情况下。目前的 PBTC 癌症分期系统应纳入 ENE 状态。此外，PHC 和 PBTC 应考虑采用不同的分期系统。
