Tan Hwee Leong, Zhao Yun, Chua Darren Weiquan, Goh Brian Kim Poh, Koh Ye Xin
Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital and National Cancer Centre Singapore, Academia, 20 College Road, 169856, Singapore; Duke-National University of Singapore Medical School, Singapore.
Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital and National Cancer Centre Singapore, Academia, 20 College Road, 169856, Singapore.
Pancreatology. 2025 Jun;25(4):558-568. doi: 10.1016/j.pan.2025.05.008. Epub 2025 May 16.
BACKGROUND/OBJECTIVES: Although the American Joint Committee on Cancer (AJCC) 8th edition recommends harvesting at least 12 lymph nodes for optimal staging in pancreatic ductal adenocarcinoma (PDAC), the precise lymph node yield (LNY) needed for accurate prognostication in different treatment settings remains unclear. This study aimed to identify subgroup-specific LNY cutoffs and evaluate their prognostic significance in nonmetastatic PDAC. METHODS: We analyzed 5609 patients with nonmetastatic PDAC from the Surveillance, Epidemiology, and End Results (SEER) database undergoing pancreatectomy. Patients were categorized by nodal status (N0 vs. N+) and receipt of neoadjuvant therapy (NAT) or upfront surgery (UPS). We used maximum selected rank statistics and a conditional inference tree approach to determine optimal LNY cutoffs for each subgroup. Kaplan-Meier curves and Cox proportional hazards models were employed to assess cancer-specific survival (CSS) and identify independent prognostic factors. RESULTS: Distinct LNY thresholds were identified for N0 (>13) and N+ (>10) cohorts, with the highest cutoffs in N0-NAT subgroups (>27). Across all analyses, patients exceeding these LNY cutoffs demonstrated significantly prolonged CSS. The N0-NAT group with LNY >27 achieved the longest median survival (60 months), whereas N+ patients undergoing UPS with LNY ≤10 had the poorest outcomes (16 months). Multivariate Cox regressions consistently showed that higher LNY was an independent predictor of improved survival. CONCLUSIONS: Higher LNY thresholds than the current AJCC standard of 12 appear beneficial for more accurate staging and improved survival in resected PDAC. Tailoring LNY goals based on nodal status and treatment modality may further refine prognostic stratification and guide more effective therapeutic strategies.
背景/目的:尽管美国癌症联合委员会(AJCC)第8版建议在胰腺导管腺癌(PDAC)中至少采集12枚淋巴结以进行最佳分期,但在不同治疗背景下准确预后所需的精确淋巴结收获量(LNY)仍不明确。本研究旨在确定亚组特异性LNY临界值,并评估其在非转移性PDAC中的预后意义。 方法:我们分析了监测、流行病学和最终结果(SEER)数据库中5609例接受胰腺切除术的非转移性PDAC患者。患者按淋巴结状态(N0与N+)以及是否接受新辅助治疗(NAT)或直接手术(UPS)进行分类。我们使用最大选择秩统计和条件推断树方法来确定每个亚组的最佳LNY临界值。采用Kaplan-Meier曲线和Cox比例风险模型评估癌症特异性生存(CSS)并确定独立预后因素。 结果:在N0(>13)和N+(>10)队列中确定了不同的LNY阈值,其中N0-NAT亚组的阈值最高(>27)。在所有分析中,超过这些LNY临界值的患者CSS显著延长。LNY>27的N0-NAT组中位生存期最长(60个月),而LNY≤10接受UPS的N+患者预后最差(16个月)。多变量Cox回归一致显示,较高的LNY是生存改善的独立预测因素。 结论:高于当前AJCC标准12的LNY阈值似乎有利于更准确的分期和改善切除的PDAC患者的生存。根据淋巴结状态和治疗方式调整LNY目标可能会进一步优化预后分层并指导更有效的治疗策略。
Cochrane Database Syst Rev. 2022-9-26
Health Technol Assess. 2006-9