Substaging of Lymph Node Status in Resected Pancreatic Ductal Adenocarcinoma Has Strong Prognostic Correlations: Proposal for a Revised N Classification for TNM Staging
Substaging of Lymph Node Status in Resected Pancreatic Ductal Adenocarcinoma Has Strong Prognostic Correlations: Proposal for a Revised N Classification for TNM Staging
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DOI：
10.1245/s10434-015-4861-0
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发表时间：
2015-12-01
影响因子：
3.7
通讯作者：
Adsay, Volkan
中科院分区：
文献类型：
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作者：
Basturk, Olca;Saka, Burcu;Adsay, Volkan
背景。目前的胰腺肿瘤-淋巴结-转移分期系统未纳入发生转移的淋巴结 (LN) 数量。方法。在 1649 例胰十二指肠切除术中，分析了 227 例经过特定 LN 采集方法的严格定义的胰腺导管腺癌 (PDAC)，以了解用于其他胃肠道 (GI) 器官的 LN 分期方案的预后价值。结果。收获的淋巴结中位数为 18 个，发生转移的淋巴结中位数为 3 个。175 例（77%）发现淋巴结转移。涉及的淋巴结数量与临床结果显着相关。当使用已用于上消化道器官的方案对病例进行亚分期时（N0：无转移，N1：转移至 1-2 个淋巴结；N2：转移至 >= 3 个淋巴结），中位总生存时间分别为 35、21 和 18 个月，3 年生存率分别为 46%、34% 和 20%（p = 0.004）。对监测、流行病学和最终结果 (SEER) 数据库的分析也证实了这些亚阶段之间的生存差异（中位总生存时间分别为 23、15 和 14 个月，3 年生存率分别为 37%、22% 和 18%；p < 0.0001）。下消化道器官的分期方案（N0：无转移；N1：转移至 1-3 个淋巴结；N2：转移至 >= 4 个淋巴结）也很重要，中位总生存时间为 35、21、18 个月，3 年生存率分别为 46%、26% 和 23%； p = 0.009）。尽管根据 Akaike 信息标准方法，上 GI 方案的预后价值似乎稍强，但两种方案的多变量模型中，较高 N 分期和较短生存期之间的关联仍然存在。结论。总之，通过适当的 LN 采集，PDAC 中的 LN 转移率非常高 (77%)。 LN 转移的分期具有重要的预后价值，需要在 PDAC 的 N 分期中予以考虑。尽管下胃肠道方案也适用，但已经用于其他上胃肠道器官的方案（目前也被证明对壶腹部也很重要）将是更可取的。
Background. The current tumor-node-metastasis staging system for the pancreas does not incorporate the number of lymph nodes (LNs) with metastasis.Methods. Among 1649 pancreaticoduodenectomies, 227 stringently defined pancreatic ductal adenocarcinomas (PDACs) that had undergone a specific approach of LN harvesting were analyzed for the prognostic value of LN substaging protocols used for other gastrointestinal (GI) organs.Results. The median number of LNs harvested was 18, and the median number of LNs with metastasis was 3. Lymph node metastasis was detected in 175 cases (77 %). The number of LNs involved correlated significantly with clinical outcome. When cases were substaged with the protocol already in use for the upper GI organs (N0: no metastasis, N1: metastasis to 1-2 LNs; N2: metastasis to >= 3 LNs), the median overall survival times were 35, 21, and 18 months, and the respective 3-year survival rates were 46, 34, and 20 % (p = 0.004). Analysis of the Surveillance, Epidemiology and End Results (SEER) database also confirmed the survival differences between these substages (median overall survival times of 23, 15, and 14 months and respective 3-year survival rates of 37, 22, and 18 %; p < 0.0001). The substaging protocol for the lower GI organs (N0: no metastasis; N1: metastasis to 1-3 LNs; N2: metastasis to >= 4 LNs) also was significant, with median overall survival times of 35, 21, 18 months and respective 3-year survival rates of 46, 26, and 23 %; p = 0.009). The association between higher N stage and shorter survival persisted with multivariate modeling for both protocols, although the prognostic value of the upper GI protocol appeared to be slightly stronger according to the Akaike Information Criterion method.Conclusion. In conclusion, with proper LN harvesting, the LN metastasis rate in PDACs is very high (77 %). Sub-staging of LN metastasis has significant prognostic value and needs to be considered in the N staging of PDACs. The protocol already in use for other upper GI tract organs, which currently also is proven significant for ampulla, would be preferable, although the lower GI tract protocol also is applicable.