Lee Woohyung, Park Jeein, Shin Aram, Lee Mirang, Sung Min Kyu, Hong Kwangpyo, Park Yejong, Song Ki Byung, Lee Jae Hoon, Hwang Dae Wook, Kim Song Cheol
Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, Brain Korea 21 Project, University of Ulsan College of Medicine, Seoul, Republic of Korea.
University of Ulsan College of Medicine, Seoul, Republic of Korea.
HPB (Oxford). 2025 Aug;27(8):1070-1077. doi: 10.1016/j.hpb.2025.04.011. Epub 2025 Apr 22.
The prognostic value of nodal staging in patients undergoing surgery for borderline resectable (BRPC) and locally advanced pancreatic cancer (LAPC) remains unclear. This study evaluated a novel system based on metastatic lymph nodes (nMLN).
Patients who underwent surgery were categorized into upfront surgery (UP) and neoadjuvant chemotherapy (NAT) groups. In the NAT group, the nMLN system was developed using K-adaptive partitioning, classifying patients by the number of metastatic lymph nodes (nMLN0: 0; nMLN1: 1-4; nMLN2: ≥5). Prognostic performance was compared between the nMLN and AJCC 8th edition systems using time-dependent area under the curve (AUC) analyses.
A total of 730 UP and 347 NAT patients were included. Compared to the UP group, the NAT group had fewer N1 cases (P = 0.032) and less lymphovascular invasion (P < 0.001). The nMLN system significantly stratified overall survival (OS) and recurrence-free survival (RFS) in NAT (P < 0.001) and UP groups (P < 0.001). Prognostic performance was comparable between the nMLN and AJCC 8th systems for OS (AUC: 0.628 vs. 0.629) and RFS (AUC: 0.643 vs. 0.649).
Both the nMLN and AJCC 8th staging systems provide effective prognostic stratification and are applicable in NAT and UP settings.
对于接受手术治疗的可切除边缘性（BRPC）和局部晚期胰腺癌（LAPC）患者，淋巴结分期的预后价值仍不明确。本研究评估了一种基于转移淋巴结（nMLN）的新系统。
将接受手术的患者分为 upfront 手术（UP）组和新辅助化疗（NAT）组。在 NAT 组中，使用 K 自适应划分法开发 nMLN 系统，根据转移淋巴结数量对患者进行分类（nMLN0：0 个；nMLN1：1 - 4 个；nMLN2：≥5 个）。使用时间依赖性曲线下面积（AUC）分析比较 nMLN 系统和 AJCC 第 8 版系统的预后性能。
共纳入 730 例 UP 患者和 347 例 NAT 患者。与 UP 组相比，NAT 组的 N1 病例较少（P = 0.032），且淋巴管侵犯较少（P < 0.001）。nMLN 系统在 NAT 组（P < 0.001）和 UP 组（P < 0.001）中对总生存期（OS）和无复发生存期（RFS）进行了显著分层。nMLN 系统和 AJCC 第 8 版系统在 OS（AUC：0.628 对 0.629）和 RFS（AUC：0.643 对 0.649）方面的预后性能相当。
nMLN 系统和 AJCC 第 8 版分期系统均能提供有效的预后分层，适用于 NAT 和 UP 情况。
