Lymph node dissection impact on staging and survival of extrahepatic cholangiocarcinomas, based on US population data
Lymph node dissection impact on staging and survival of extrahepatic cholangiocarcinomas, based on US population data
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DOI：
10.1007/s11605-006-0018-6
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发表时间：
2007-02-01
影响因子：
3.2
通讯作者：
Smith, David D.
中科院分区：
文献类型：
--
作者：
Schwarz, Roderich E.;Smith, David D.
胆管癌（CC）经常表现出淋巴扩散。我们根据 SEER 1973-2004 数据库研究了肝外 CC 切除后的淋巴结 (LN) 计数和生存率。在 20,068 名 CC 患者中，根据 M0 分期选择了 1,518 名患者，并至少检查了一名淋巴结。原发癌部位包括胆囊（29%）、肝外胆管（26%）和胰内/壶腹部胆管（45%）； 42% 的患者 LN 呈阳性。检查的 LN 的中位数为 4（范围 1-39）。 LN 阴性癌症的中位生存期为 37 个月，LN 阳性癌症的中位生存期为 16 个月。多变量预后变量包括阳性淋巴结数量、原发部位、年龄（均 p < 0.0001）、性别（p=0.002）、大小（p=0.005）、T 类别（p=0.009）和总淋巴结计数（或获得的阴性淋巴结数量，p=0.01）。总 LN 计数的影响见于 LN 阴性（中位生存期，检查 1 个与 10 个或更多 LN：27 个月与 51 个月，p=0.002）和 LN 阳性疾病（10 个月与 22 个月，p < 0.0001）。肝外 CC 的生存预测受到总 LN 计数和获得的阴性 LN 数量的强烈影响。尽管由此产生的增量效益很小，但应考虑对 10 个或更多淋巴结进行解剖和检查以进行治愈性切除。
Cholangiocarcinomas (CC) frequently demonstrate lymphatic spread. We investigated lymph node (LN) counts after resection of extrahepatic CC and survival based on the SEER 1973-2004 database. Out of 20,068 CC patients, 1,518 individuals were selected based on M0 stage and at least one LN examined. Primary cancer sites included gallbladder (29%), extrahepatic bile ducts (26%), and intrapancreatic/ampullary bile ducts (45%); 42% of patients were LN-positive. The median number of LNs examined was four (range 1-39). Median survival was 37 months for LN-negative and 16 months for LN-positive cancers. Multivariate prognostic variables were the number of positive LNs, primary site, age (all at p < 0.0001), gender (p=0.002), size (p=0.005), T category (p=0.009), and total LN count (or number of negative LNs obtained, p=0.01). The impact of total LN counts was seen in LN-negative (median survival, 1 vs 10 or more LNs examined: 27 vs 51 months, p=0.002) and LN-positive disease (10 vs 22 months, p < 0.0001). Survival prediction of extrahepatic CCs is strongly influenced by total LN counts and numbers of negative LNs obtained. Although the resulting incremental benefit is small, dissection and examination of 10 or more LNs should be considered for curative intent resections.