Zheng Yangyang, Li Rui, Xu Jingyong, Shi Haowei, Xing Cheng, Li Zhe, Cui Hongyuan, Song Jinghai
Department of General Surgery, Department of Hepato-Bilio-Pancreatic Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, No. 1 Da Hua Road, Dong Dan, Beijing, 100730, People's Republic of China.
Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, People's Republic of China.
Updates Surg. 2025 Jan 11. doi: 10.1007/s13304-025-02075-7.
This study aimed to evaluate and compare the predictive performance of negative lymph nodes (NLN), lymph node ratio (LNR), and N stage in pancreatic ductal adenocarcinoma (PDAC) among patients with ≤ 12 retrieved lymph nodes and those with > 12 retrieved lymph nodes. Moreover, the association between the three nodal staging systems and survival was also explored. Clinical data on patients diagnosed with PDAC between 2004 and 2020 were downloaded from the Surveillance, Epidemiology, and End Results (SEER) database. Cox regression was performed to identify independent predictors of cancer specific survival (CSS) and overall survival (OS). Survival probability was calculated and compared by the Kaplan-Meier method and log rank test. Akaike information criterion (AIC) and Harrell's C-index were used to evaluate the prognostic ability of each nodal staging system. All three lymph node staging systems were independent predictors of CSS and OS. A higher NLN, a lower N stage, and a lower LNR were associated with improved survival. Compared with N stage, LNR staging performed better with a lower AIC and higher C-index for predicting the prognosis regardless of the sufficiency of retrieved lymph nodes, while NLN staging performed poorly in both the training and validation set. Subgroup analyses showed that the NLN successfully predicted survival outcomes in both lymph node-positive and node-negative patients. LNR demonstrated better predictive performance in PDAC patients regardless of the sufficiency of retrieved lymph nodes. Notably, for stage N0 disease, NLN was a more important prognostic predictor. The combination of LNR and NLN may offer more precise information on lymph node staging than the current staging system.
本研究旨在评估和比较在胰腺导管腺癌（PDAC）中，阴性淋巴结（NLN）、淋巴结比率（LNR）和N分期在获取淋巴结≤12个的患者与获取淋巴结>12个的患者中的预测性能。此外，还探讨了这三种淋巴结分期系统与生存之间的关联。从监测、流行病学和最终结果（SEER）数据库下载了2004年至2020年间诊断为PDAC的患者的临床数据。进行Cox回归以确定癌症特异性生存（CSS）和总生存（OS）的独立预测因素。通过Kaplan-Meier法和对数秩检验计算并比较生存概率。使用赤池信息准则（AIC）和Harrell's C指数评估每个淋巴结分期系统的预后能力。所有三种淋巴结分期系统都是CSS和OS的独立预测因素。较高的NLN、较低的N分期和较低的LNR与生存改善相关。与N分期相比，无论获取淋巴结是否充足，LNR分期在预测预后方面表现更好，AIC较低且C指数较高，而NLN分期在训练集和验证集的表现均较差。亚组分析表明，NLN在淋巴结阳性和阴性患者中均成功预测了生存结果。无论获取淋巴结是否充足，LNR在PDAC患者中均表现出更好的预测性能。值得注意的是，对于N0期疾病，NLN是更重要的预后预测因素。与当前分期系统相比，LNR和NLN的组合可能提供更精确的淋巴结分期信息。
