The number and ratio of positive lymph nodes affect pancreatic cancer patient survival after neoadjuvant therapy and pancreaticoduodenectomy.
The number and ratio of positive lymph nodes affect pancreatic cancer patient survival after neoadjuvant therapy and pancreaticoduodenectomy.
复制标题
DOI：
10.1111/his.12732
复制
发表时间：
2016-01
期刊：
影响因子：
6.4
通讯作者：
Wang H
中科院分区：
文献类型：
--
作者：
Fischer LK;Katz MH;Lee SM;Liu L;Wang H;Varadhachary GR;Wolff RA;Lee JE;Maitra A;Roland CL;Fleming JB;Estrella J;Rashid A;Wang H
本研究旨在探讨胰腺导管腺癌（PDAC）新辅助治疗后胰十二指肠切除术（PD）中阳性淋巴结数量和比例的意义。我们的研究人群包括398例连续PDAC患者，他们在1999年至2012年期间完成了新辅助治疗和PD。淋巴结状态分为ypN 0（淋巴结阴性）、ypN 1（1-2个阳性淋巴结）和ypN 2（≥3个阳性淋巴结），并与无病生存期（DFS）和总生存期（OS）相关。ypN 0、ypN 1和ypN 2阳性分别为183例（46.0%）、117例（29.4%）和98例（24.6%）。此外，162例（40.7%）淋巴结比率（LNR）≤ 0.19，53例（13.3%）LNR > 0.19。ypN 1型患者的DFS和OS均短于ypN 0型患者，而优于ypN 2型患者（P<0.05）。同样，LNR≤0.19的患者的DFS和OS也优于LNR≤0.19的患者（P<0.001）。多因素分析显示，淋巴结阳性数和LNR是影响DFS和OS的独立预后因素，治疗后淋巴结阳性组分为ypN 1（1-2个阳性淋巴结）和ypN 2（≥ 3个阳性淋巴结）应纳入PDAC患者的AJCC分期。
This study is to examine the significance of the number and ratio of positive nodes in post neoadjuvant therapy pancreaticoduodenectomy (PD) for pancreatic ductal adenocarcinoma (PDAC). Our study population consisted of 398 consecutive PDAC patients, who completed neoadjuvant therapy and PD between 1999 and 2012. Lymph node status was classified as ypN0 (node negative), ypN1 (1–2 positive nodes) and ypN2 (≥3 positive nodes) and correlated with disease-free survival (DFS) and overall survival (OS). The ypN0, ypN1 and ypN2 was present in 183 (46.0%), 117 (29.4%) and 98 (24.6%) patients respectively. Additionally, 162 (40.7%) had a lymph node ratio (LNR) ≤ 0.19 and 53 (13.3%) had a LNR > 0.19. Patients with ypN1 disease had shorter DFS and OS than those with ypN0 disease, but better DFS and OS than those with ypN2 disease (P<0.05). Similarly, patients with a LNR≤0.19 had better DFS and OS than those with a LNR≤0.19 (P<0.001). In multivariate analysis, both the number of positive nodes and LNR were independent prognostic factors for DFS and OS. Subclassification of post-therapy node positive group into ypN1 (1–2 positive nodes) and ypN2 (≥ 3 positive nodes) should be incorporated into the AJCC staging of PDAC patients.