Does direct invasion of peripancreatic lymph nodes impact survival in patients with pancreatic ductal adenocarcinoma? A retrospective dual-center study
Does direct invasion of peripancreatic lymph nodes impact survival in patients with pancreatic ductal adenocarcinoma? A retrospective dual-center study
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DOI：
10.1016/j.pan.2021.03.008
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发表时间：
2021-08-04
期刊：
影响因子：
3.6
通讯作者：
Sho, Masayuki
中科院分区：
文献类型：
--
作者：
Hashimoto, Daisuke;Satoi, Sohei;Sho, Masayuki
背景资料：胰腺导管腺癌可直接侵犯胰周淋巴结，但直接侵犯淋巴结的意义存在争议，目前将其归类为淋巴结转移。本研究旨在确定胰腺导管腺癌患者直接侵犯胰周淋巴结对生存率的影响。研究方法：回顾性评价了2006年至2016年在两个高容量中心接受胰腺切除术的411例可切除/边缘性可切除胰腺导管腺癌患者。结果如下：60例（14.6%）患者直接侵犯胰周淋巴结而无孤立淋巴结转移（N-direct组），189例（46.0%）患者有孤立淋巴结转移（N-met组），162例（39.4%）患者既无直接侵犯也无孤立淋巴结转移（N 0组）。N-direct组（35.0个月）和N 0组（45.6个月）之间的中位总生存期无显著差异（p = 0.409），但N-direct组的生存期显著长于N-met组（25.0个月）（p = 0.003）。同样，N-direct组（21.0个月）和N 0组（22.7个月）的中位无病生存期相似（p = 0.151），但N-direct组的中位无病生存期显著长于N-met组（14.0个月）（p < 0.001）。多变量分析确定可切除性、辅助化疗和孤立淋巴结转移是总生存率的独立预测因素。然而，直接淋巴结浸润不是生存的预测因子。结论：直接侵犯胰周淋巴结对胰腺导管腺癌行胰腺切除术患者的生存率没有影响，因此不应归类为淋巴结转移。(c)2021由Elsevier B. V.代表IAP和EPC发布。
Background: Pancreatic ductal adenocarcinoma can directly invade the peripancreatic lymph nodes; however, the significance of direct lymph node invasion is controversial, and it is currently classified as lymph node metastasis. This study aimed to identify the impact of direct invasion of peripancreatic lymph nodes on survival in patients with pancreatic ductal adenocarcinoma. Methods: A total of 411 patients with resectable/borderline resectable pancreatic ductal adenocarcinoma who underwent pancreatic resection at two high-volume centers from 2006 to 2016 were evaluated retrospectively. Results: Sixty (14.6%) patients had direct invasion of the peripancreatic lymph nodes without isolated lymph node metastasis (N-direct group), 189 (46.0%) had isolated lymph node metastasis (N-met group), and 162 (39.4%) had neither direct invasion nor isolated metastasis (N0 group). There was no significant difference in median overall survival between the N-direct group (35.0 months) and the N0 group (45.6 month) (p = 0.409), but survival was significantly longer in the N-direct compared with the N-met group (25.0 months) (p = 0.003). Similarly, median disease-free survival was similar in the N-direct (21.0 months) and N0 groups (22.7 months) (p = 0.151), but was significantly longer in the N-direct compared with the N-met group (14.0 months) (p < 0.001). Multivariate analysis identified resectability, adjuvant chemotherapy, and isolated lymph node metastasis as independent predictors of overall survival. However, direct lymph node invasion was not a predictor of survival. Conclusion: Direct invasion of the peripancreatic lymph nodes had no effect on survival in patients undergoing pancreatic resection for pancreatic ductal adenocarcinoma, and should therefore not be classified as lymph node metastasis. (c) 2021 Published by Elsevier B.V. on behalf of IAP and EPC.