Prognostic significance of pathologic nodal status in patients with resected pancreatic cancer
Prognostic significance of pathologic nodal status in patients with resected pancreatic cancer
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DOI：
10.1007/s11605-007-0243-7
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发表时间：
2007-11-01
影响因子：
3.2
通讯作者：
Allen, Peter J.
中科院分区：
文献类型：
--
作者：
House, Michael G.;Goenen, Mithat;Allen, Peter J.
背景本研究的目的是评估病理淋巴结评估和淋巴结转移程度对胰腺癌患者预后的意义。材料和方法回顾了前瞻性维护的胰腺癌数据库，并确定了1995年至2005年期间接受胰腺癌切除术的696例连续患者。总生存率与淋巴结（LN）状态、病理学评估LN的绝对数量和LN比率（阳性LN占总LN assessed.Results的数量）进行比较，在696例患者中，598例（86%）行胰腺切除术（PD），96例（14%）行远端胰腺切除术（DP）。对于所有患者，中位随访时间为13个月（范围，0-122个月），估计5年生存率为16%。共有243例（35%）患者为LN阴性（N 0），中位生存期为27个月。当作为一个连续变量进行评估时，病理学评估的LN数量与接受PD或DP的N 0患者的生存率无关。453例淋巴结阳性（N1）患者的中位生存期为16个月。当作为一个连续变量进行分析时，阳性淋巴结的绝对数量是N1患者生存的一个重要预测因子，线性关系高达8个阳性淋巴结。LN比值作为一个连续变量，也预测生存率，线性关系高达0.35的比率。比值0.18与19个月的中位生存期相关，P <0.01。结论淋巴结阳性绝对数量和淋巴结比值是预测胰腺癌患者生存期的重要指标。不充分的手术淋巴结切除术或病理LN评估低估了淋巴结阴性患者。
Background The purpose of this study was to evaluate the significance of pathologic nodal assessment and extent of nodal metastases on patient outcome in patients with pancreatic adenocarcinoma.Materials and Methods A prospectively maintained pancreatic cancer database was reviewed, and 696 consecutive patients were identified who underwent resection for pancreatic adenocarcinoma between 1995 and 2005. Overall survival was compared to lymph node (LN) status, absolute number of pathologically assessed LN, and LN ratio expressed as the number of positive LN to the total LN assessed.Results Of the 696 patients, 598 (86%) had pancreaticoduodenectomy (PD), and 96 (14%) had distal pancreatectomy (DP). For all patients, median follow-up was 13 months (range, 0-122 months), and estimated 5-year survival was 16%. A total of 243 (35%) patients were LN-negative (N0) and had a median survival of 27 months. When assessed as a continuous variable, the number of pathologically assessed LN did not correlate with survival for N0 patients undergoing either PD or DP. The median survival for the 453 patients with node-positive (N1) disease was 16 months. When analyzed as a continuous variable, the absolute number of positive LNs was a significant predictor of survival for N1 patients with a linear relationship up to eight positive LNs. LN ratio, as a continuous variable, also predicted survival with a linear relationship up to a ratio of 0.35. A ratio of 0.18 was associated with a 19-month median survival and served as the best cutoff, p < 0.01.Conclusions The absolute number of positive LNs and LN ratio are strong predictors of survival for patients with node-positive pancreatic adenocarcinoma. Inadequate surgical lymphadenectomy or pathologic LN assessment understages node-negative patients.