Which patients with para-aortic lymph node (LN16) metastasis will truly benefit from curative pancreaticoduodenectomy for pancreatic head cancer?
Which patients with para-aortic lymph node (LN16) metastasis will truly benefit from curative pancreaticoduodenectomy for pancreatic head cancer?
复制标题
哪些主动脉旁淋巴结（LN16）转移的患者将真正受益于胰头癌的根治性胰十二指肠切除术？
DOI：
10.18632/oncotarget.8690
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发表时间：
2016-05-17
期刊：
影响因子：
--
通讯作者：
Yu X
中科院分区：
文献类型：
--
作者：
Liu C;Lu Y;Luo G;Cheng H;Guo M;Liu Z;Xu J;Long J;Liu L;Fu D;Ni Q;Li M;Yu X
在胰头癌患者中，转移到主动脉旁淋巴结（LN 16）被认为是远处转移和预后不良的标志物。然而，LN 16参与胰头癌的发生率很高，目前还不清楚是否所有此类患者的手术结果都很差。我们通过回顾性分析中国两个高容量中心接受主动脉旁淋巴结清扫术的579例导管腺癌患者，研究了LN 16参与可切除胰头癌的意义。根据肿瘤位置，LN 16转移的发生率以及LN 16受累与第1组或第2组淋巴结受累之间的相关性显著不同。转移至LN 16表明高血清肿瘤负荷和不良预后，尽管淋巴结比率（LNR）< 0.25的LN 16阳性患者仍可能受益于根治性手术。对LN 16阳性的可切除胰头癌患者的生存分析显示，肿瘤大小、肿瘤分化程度和肿瘤位置是独立的预后因素。我们还发现，术前血清CA 125 < 18.62 U/ml和JAK 2信号水平都是胰头癌根治性手术切除的受益指标。
In patients with cancer of the pancreatic head, metastasis to para-aortic lymph nodes (LN16) is considered distant metastasis and a poor prognostic marker. However, the incidence of LN16 involvement in pancreatic head cancer is high, and it is unclear whether all such patients have poor surgical outcomes. We investigated the significance of LN16 involvement in resectable pancreatic head cancer by retrospectively analyzing 579 ductal adenocarcinoma patients treated with para-aortic lymph node dissection at two high-volume Chinese centers. Depending upon tumor location, the incidence of LN16 metastasis and the correlation between LN16 involvement and involvement of Group 1 or 2 lymph nodes significantly differed. Metastasis to LN16 indicated a high serum tumor burden and a poor prognosis, though LN16-positive patients with a lymph node ratio (LNR) < 0.25 may still benefit from radical surgery. Survival analysis of LN16-positive patients with resectable pancreatic head cancer revealed that tumor size, tumor differentiation, and tumor location are independent prognostic factors. We also found that preoperative serum CA125 < 18.62 U/ml and the level of JAK2 signaling are both indicators of who may benefit from curative surgical resection for pancreatic head cancer.
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