Prognostic Significance of Lymph Node Metastases in Pancreatic Head Cancer Treated with Extended Lymphadenectomy: Not Just a Matter of Numbers
Prognostic Significance of Lymph Node Metastases in Pancreatic Head Cancer Treated with Extended Lymphadenectomy: Not Just a Matter of Numbers
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DOI：
10.1245/s10434-009-0672-5
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发表时间：
2009-12-01
影响因子：
3.7
通讯作者：
Capussotti, Lorenzo
中科院分区：
文献类型：
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作者：
Massucco, Paolo;Ribero, Dario;Capussotti, Lorenzo
胰头癌切除患者中与结节转移相关的变量(结节状态、阳性结节数目[posNn]、结节比[Nr]和转移部位)的预后意义仍不明确。对连续77例接受胰头腺癌扩大淋巴清扫术的患者的临床、手术和病理资料进行了分析，其中59例(77%)有淋巴转移。LN计数、posNn和Nr的中位数分别为28(10-54)、4(1-29)和14%(2%-55%)。26例(44%)转移局限于结节水平(NL)1(即胰周结节)，21例(36%)转移至NL2(沿主要动脉和肝门的转移)，12例(20%)转移至NL3(腹主动脉前淋巴结)。有趣的是，仅限于N11的LN阳性患者的存活率与淋巴结阴性患者相似(P=0.407)。PosNn、Nr和Nl都是生存的重要预测因素(P<；0.015)。PosNn和Nr被证明是NL受累的准确指标。PoNn的最佳分界值为2，Nr的最佳分界值为10%。在胰头癌中，有无淋巴结转移是一个有统计学意义的预后因素。PosNn和Nr都是NL的准确指标，并可能改善患者的危险分层。
The prognostic significance of variables related to nodal involvement (node status, number of disease-positive nodes [posNn], node ratio [Nr], and site of nodal metastases) in patients with resected pancreatic head cancer remains poorly defined.Clinical, operative, and pathologic data, including indexes of the burden and extent of nodal involvement, were analyzed in a consecutive series of 77 patients who underwent resection with extended lymphadenectomy for adenocarcinoma of the pancreatic head.Fifty-nine patients (77%) were found to have lymph node (LN) metastases. Median LN count, posNn, and Nr were 28 (10-54), 4 (1-29), and 14% (2%-55%), respectively. Twenty-six patients (44% of N1) had metastases limited to node level (NL) 1 (i.e., peripancreatic nodes); metastases up to NL2 (nodes along main arteries and hepatic hilum) and NL3 (preaortic nodes) were found in 21 (36%) and 12 (20%) patients, respectively. Interestingly, survival of patients with positive LN limited to NL1 was similar to that of node-negative patients (P = 0.407). posNn, Nr, and NL were all significant predictors of survival (P < 0.015). posNn and Nr proved to be an accurate proxy of NL involvement. The best cutoff of posNn was 2 and of and Nr was 10%.The level of nodal metastatic spread is a statistically significant prognostic factor in cancer of the pancreatic head. Both posNn and Nr are accurate proxy of NL and may improve patients' risk stratification.