Ishikawa O, Ohigashi H, Sasaki Y, Kabuto T, Furukawa H, Nakamori S, Imaoka S, Iwanaga T, Kasugai T
Department of Surgery, Osaka Medical Center for Cancer, Japan.
Surgery. 1997 Mar;121(3):244-9. doi: 10.1016/s0039-6060(97)90352-4.
Until recently long-term survival has not been expected when at least one positive node was detected at any site in pancreatic head cancer treated by conventional pancreatectomy. However, even when nodal involvement is seen, there has been an increasing number of long-term survivors after extended pancreatectomy in which a wide range of lymphatic and connective tissues were cleared. Thus the purpose of the present study was to establish a practical rational grouping of positive lymph nodes in pancreatic head cancer treated by extended pancreatectomy.
In 81 patients who tolerated extended pancreatectomy for cancer of the pancreatic head, a mean of 56 +/- 23 (range, 28 to 89) lymph nodes in each patient were examined under a microscope to determine the presence or absence of cancer. They were classified anatomically into 14 lymph node groups, and the incidence, distribution, and number of positive nodes were examined. A simplified grouping was made on the basis of the histologic findings and was checked against long-term survival rates.
Nodal involvement was detected in 59 (73%) of 81 patients, and positive nodes were more commonly observed in the posterior pancreaticoduodenal (PPD), superior mesenteric (SM), and anterior pancreaticoduodenal (APD) groups than in the 11 other groups (p < 0.05). The PPD, APD, and SM groups offered the sole sites of nodal involvement with incidence levels of 23%, 17%, and 6%, respectively, whereas none of the 11 other groups did. Thus patients were classified into four groups: (a), negative in all 14 lymph node groups (n = 22); (b), positive but limited to the PPD/APD groups (n = 14); (c), also positive in the SM group, but negative in the 11 other groups (n = 13); and (d), also positive in at least one of the 11 other groups (n = 32). This classification was associated well with the 5-year survival rate: 59% in group (a), 53% in group (b), 15% in group (c), and 0% in group (d) [p < 0.05; group (b) versus group (c)]. Also this grouping associated well with the total number of positive nodes (p < 0.05). The 5-year survival rate in patients with one to three positive nodes was 47% and was more than 6% in patients with four to seven positive nodes (p < 0.05).
In the clinicopathologic staging of the lymphatic spread from carcinoma of the pancreatic head, the PPD and APD groups were considered the first stations of lymphatic metastasis, whereas the 12 other groups-including the SM group-were categorized as second or more distant stations.
直到最近，在接受传统胰腺切除术治疗的胰头癌患者中，若在任何部位检测到至少一个阳性淋巴结，人们都不期望其能长期存活。然而，即便发现有淋巴结受累，在扩大胰腺切除术中清除了广泛的淋巴组织和结缔组织后，长期存活者的数量也在不断增加。因此，本研究的目的是为接受扩大胰腺切除术治疗的胰头癌患者建立一个实用且合理的阳性淋巴结分组。
在81例耐受扩大胰腺切除术治疗胰头癌的患者中，对每位患者平均56±23（范围28至89）个淋巴结进行显微镜检查以确定是否存在癌细胞。将它们按解剖学分为14个淋巴结组，并检查阳性淋巴结的发生率、分布和数量。根据组织学结果进行简化分组，并与长期生存率进行对照。
81例患者中有59例（73%）检测到淋巴结受累，与其他11个组相比，胰十二指肠后（PPD）、肠系膜上（SM）和胰十二指肠前（APD）组的阳性淋巴结更常见（p<0.05）。PPD、APD和SM组是仅有的有淋巴结受累的部位，发生率分别为23%、17%和6%，而其他11个组均无。因此，患者被分为四组：（a），14个淋巴结组均为阴性（n = 22）；（b），阳性但仅限于PPD/APD组（n = 14）；（c），SM组也为阳性，但其他11个组为阴性（n = 13）；（d），其他11个组中至少有一组为阳性（n = 32）。这种分类与5年生存率密切相关：（a）组为59%，（b）组为53%，（c）组为15%，（d）组为0%[p<0.05；（b）组与（c）组相比]。而且这种分组与阳性淋巴结总数也密切相关（p<0.05）。有1至3个阳性淋巴结的患者5年生存率为47%，有4至7个阳性淋巴结的患者5年生存率超过6%（p<0.05）。
在胰头癌淋巴转移的临床病理分期中，PPD和APD组被认为是淋巴转移的第一站，而包括SM组在内的其他12个组被归类为第二站或更远的站。
