Impact of lymph node ratio on survival in patients with pancreatic and periampullary cancer
Impact of lymph node ratio on survival in patients with pancreatic and periampullary cancer
复制标题
DOI：
10.1002/bjs.9709
复制
发表时间：
2015-02-01
影响因子：
9.6
通讯作者：
Gouma, D. J.
中科院分区：
文献类型：
--
作者：
Tol, J. A. M. G.;Brosens, L. A. A.;Gouma, D. J.
背景资料：根据一些研究，转移的淋巴结数量与切除的淋巴结总数的关系，淋巴结比率（LNR），是胰腺癌患者切除后生存率的最有力预测因素之一。然而，矛盾的结果已被报道，和小样本量的队列和不同的定义的显微镜阳性切除边缘（R1）妨碍数据的解释。方法：LNR的预测值为3年生存率进行了评估，使用考克斯比例风险模型。从1992年至2012年，从数据库中选择了所有接受胰腺切除术的胰腺癌和壶腹周围癌患者。分析其临床病理特征。显微镜下阳性切缘定义为切缘1 mm内显微镜下存在肿瘤细胞。结果：共纳入760例患者。列线图中包含的350例胰腺导管腺癌患者的死亡预测因素为：R1切除（风险比（HR）1.55，95%置信区间）。1.07至2.25）、肿瘤分化差（HR 2.78，1.40至5.52）、LNR高于0.18（HR 1.75，1.13至2.70）和无辅助治疗（HR 1.54，1.01至2.34）。C统计量为0.658（0.632至0.698），校准良好（Hosmer-Lemeshow chi（2）= 5.67，P = 0.773）。LNR和肿瘤分化差（HR分别为4.51和3.30）也是胆总管远端癌患者的预测指标。LNR、R1切除和黄疸是壶腹癌患者死亡的预测因子（HR分别为7.82、2.68和1.93）。
Background: According to some studies, the number of lymph nodes with metastases in relation to the total number of removed lymph nodes, the lymph node ratio (LNR), is one of the most powerful predictors of survival after resection in patients with pancreatic cancer. However, contradictory results have been reported, and small sample sizes of the cohorts and different definitions of a microscopic positive resection margin (R1) hamper the interpretation of data.Methods: The predictive value of LNR for 3-year survival was assessed using a Cox proportional hazards model. From 1992 to 2012, all patients with pancreatic and periampullary cancer operated on with pancreatoduodenectomy were selected from a database. Clinicopathological characteristics were analysed. Microscopic positive resection margin was defined as the microscopic presence of tumour cells within 1 mm of the margins. A nomogram was created.Results: Some 760 patients were included. Predictive factors for death in 350 patients with pancreatic ductal adenocarcinoma included in the nomogram were: R1 resection (hazard ratio (HR) 1.55, 95 per cent c.i. 1.07 to 2.25), poor tumour differentiation (HR 2.78, 1.40 to 5.52), LNR above 0.18 (HR 1.75, 1.13 to 2.70) and no adjuvant therapy (HR 1.54, 1.01 to 2.34). The C statistic was 0.658 (0.632 to 0.698), and calibration was good (Hosmer-Lemeshow chi(2) = 5.67, P = 0.773). LNR and poor tumour differentiation (HR 4.51 and 3.30 respectively) were also predictive in patients with distal common bile duct (CBD) cancer. LNR, R1 resection and jaundice were predictors of death in patients with ampullary cancer (HR 7.82, 2.68 and 1.93 respectively).Conclusion: LNR is a common predictor of poor survival in pancreatic, distal CBD and ampullary cancer.