Determining Pattern of Recurrence Following Pancreaticoduodenectomy and Adjuvant 5-Flurouracil-Based Chemoradiation Therapy: Effect of Number of Metastatic Lymph Nodes and Lymph Node Ratio
Determining Pattern of Recurrence Following Pancreaticoduodenectomy and Adjuvant 5-Flurouracil-Based Chemoradiation Therapy: Effect of Number of Metastatic Lymph Nodes and Lymph Node Ratio
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DOI：
10.1007/s11605-008-0762-x
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发表时间：
2009-04-01
影响因子：
3.2
通讯作者：
Pawlik, Timothy M.
中科院分区：
文献类型：
--
作者：
Asiyanbola, Bolanle;Gleisner, Ana;Pawlik, Timothy M.
关于胰腺癌胰十二指肠切除术和基于 5-氟尿嘧啶的辅助放化疗后的复发模式和局部复发相关因素的数据有限。 1995 年至 2005 年间，905 名患者因胰腺腺癌接受了胰十二指肠切除术； 154 名患者拥有完整的复发模式数据。在中位随访 20.2 个月时，103 名 (66.9%) 患者复发，中位复发时间为 16.2 个月。大多数患者仅因远处疾病复发（68.9%），而21.4%的患者仅因局部疾病复发；十名（9.7%）患者出现局部和远处疾病复发。有几个因素与局部复发相关：肿瘤分化差（风险比 [HR] 2.39）和转移性淋巴结的存在（HR 1.89，均 p < 0.05）。在N1患者中，肿瘤分化差（HR 3.92）、> 5个转移性淋巴结（HR 3.75）和淋巴结比率（LNR）> 0.4（HR 2.96）局部复发风险最高（均p < 0.05）。 LNR 增加与局部复发风险增加相关（LNR < 0.2, 21.3% 相对于 LNR 千分之 0.2 至 0.4, 25.2% 相对于 LNR > 0.4, 40.4%；p < 0.05）。虽然大多数接受基于 5-氟尿嘧啶的标准放化疗的患者最终会死于远处疾病，但约 30% 的患者复发本地。肿瘤分化差、大量转移性淋巴结 (> 5) 和 LNR > 0.4 与局部失败的最高风险相关。在这些患者中，可能需要增加放射剂量和/或放射与新型化疗药物的组合来改善预后。
There are limited data on patterns of recurrence and factors associated with local recurrence following pancreaticoduodenectomy for pancreatic adenocarcinoma and adjuvant 5-flurouracil-based chemoradiation therapy.Between 1995 and 2005, 905 patients underwent pancreaticoduodenectomy for pancreatic adenocarcinoma; 154 patients had complete pattern of recurrence data available.At median follow-up of 20.2 months, 103 (66.9%) patients recurred with median time to recurrence of 16.2 months. Most patients recurred with distant disease only (68.9%), while 21.4% patients recurred with local disease only; ten (9.7%) patients recurred with local and distant disease. Several factors were associated with local recurrence: poor tumor differentiation (hazards ration [HR] 2.39) and presence of metastatic lymph nodes (HR 1.89, both p < 0.05). Among N1 patients, poor tumor differentiation (HR 3.92), > 5 metastatic LN (HR 3.75), and lymph node ratio (LNR) > 0.4 (HR 2.96) had the highest risk of local recurrence (all p < 0.05). Increasing LNR was associated with an incremental increased risk of local recurrence (LNR < 0.2, 21.3% versus LNR a parts per thousand yen0.2 to 0.4, 25.2% versus LNR > 0.4, 40.4%; p < 0.05).Although most patients who receive standard 5-flurouracil-based chemoradiation therapy will ultimately succumb to distant disease, about 30% recur locally. Poor tumor differentiation, a high number of metastatic LN (> 5), and LNR > 0.4 are associated with the highest risk of local failure. In these patients, radiation dose escalation and/or a combination of radiation with novel chemotherapeutic agents may be necessary to improve outcomes.