Degree of desmoplasia in metastatic lymph node lesions is associated with lesion size and poor prognosis in pancreatic cancer patients
Degree of desmoplasia in metastatic lymph node lesions is associated with lesion size and poor prognosis in pancreatic cancer patients
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DOI：
10.3892/ol.2017.6549
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发表时间：
2017-09-01
期刊：
影响因子：
2.9
通讯作者：
Nakamura, Masafumi
中科院分区：
文献类型：
--
作者：
Nakayama, Hiromichi;Ohuchida, Kenoki;Nakamura, Masafumi
胰腺癌的特征是纤维组织增生增加，称为结缔组织增生，淋巴结转移是这种疾病的独立预后因素。然而，目前还没有关于胰腺癌淋巴结转移中结缔组织增生的报道。本研究评估了一系列因素，并调查了它们与伴有淋巴结转移的胰腺癌病例预后不良的相关性，包括病变中结缔组织增生的程度。为了确定与淋巴结转移相关的不良预后因素，本研究回顾性分析了2007年至2012年期间在单一机构接受胰腺癌手术切除的65例淋巴结转移患者的临床数据。研究集中在216个淋巴结转移灶的纤维化程度，并调查与预后或临床病理结果的关系。评估转移性淋巴结病灶中纤维化面积的比例，并将其分为三类，高（>= 70%）、中等（10-70%）和低（< 10%）。在无癌淋巴结中未观察到结缔组织增生。另外测量转移淋巴结病灶的大小，观察到转移病灶的大小与结缔组织增生程度之间有显著相关性（P < 0.001）。结缔组织增生的程度还与局部结节浸润有关。在对65例胰腺癌伴淋巴结转移患者的分析中，多发性淋巴结转移伴中度或高度结缔组织增生与生存率低显著相关（高，P=0.0048;中/高，P=0.0075）。在几个临床病理因素中，在单变量（P=0.0098）和多变量（P=0.0466）分析中，多发转移淋巴结伴高度或中度结缔组织增生与总生存率相关。转移淋巴结中结缔组织增生的程度与病灶大小有关，多个转移淋巴结伴结缔组织增生是独立的不良预后因素，提示结缔组织增生可能在淋巴结转移的恶性进展中起重要作用。
Pancreatic cancer is characterized by increased hyperplasia of fibrotic tissue, termed desmoplasia, and lymph node metastasis is an independent prognostic factor in this disease. However, there are no reports focused on desmoplasia in pancreatic cancer lymph node metastases. The present study evaluated a range of factors and investigated their association with poor prognosis in pancreatic cancer cases with lymph node metastasis, including the degree of desmoplasia in lesions. To identify the poor prognostic factors associated with lymph node metastasis, the present study retrospectively reviewed the clinical data of 65 patients with lymph node metastases that underwent surgical pancreatic cancer resection between 2007 and 2012 at a single institution. The investigation focused on the degree of fibrosis in metastatic lesions in 216 lymph nodes, and investigated associations with prognosis or clinicopathological findings. The ratios of the fibrotic area in metastatic lymph node lesions were evaluated and classified into three categories, high (>= 70%), moderate (10-70%) and low (< 10%). Desmoplasia was not observed in cancer-free lymph nodes. The size of metastatic lymph node lesions was additionally measured, and a significant association between metastatic lesion size and the degree of desmoplasia was observed (P < 0.001). The degree of desmoplasia was additionally associated with local extranodal invasion. In the analysis of 65 pancreatic cancer patients with metastatic lymph nodes, the presence of multiple metastatic lymph nodes with moderate or high desmoplasia was significantly associated with poor survival (high, P=0.0048; moderate/high, P=0.0075). Of several clinicopathological factors, the presence of multiple metastatic lymph nodes with high or moderate desmoplasia was associated with overall survival in univariate (P=0.0098) and multivariate (P=0.0466) analyses. The degree of desmoplasia in metastatic lymph nodes is associated with lesion size, and the presence of multiple metastatic lymph nodes with desmoplasia is an independent poor prognostic factor, suggesting that the desmoplasia may have an important role in the malignant progression of lymph node metastases.