Metastatic lymph node ratio as an important prognostic factor in pancreatic ductal adenocarcinoma
Metastatic lymph node ratio as an important prognostic factor in pancreatic ductal adenocarcinoma
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DOI：
10.1016/j.ejso.2011.12.020
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发表时间：
2012-04-01
期刊：
影响因子：
3.8
通讯作者：
White, S. A.
中科院分区：
文献类型：
--
作者：
Robinson, S. M.;Rahman, A.;White, S. A.
背景：总体而言，导管腺癌患者行胰十二指肠切除术后的五年生存率很低，文献报道的典型生存率为8-27%。这项研究的目的是确定最能预测这些患者长期生存的组织学变量。方法：对2002年4月至2009年6月间接受胰腺十二指肠切除术的患者的前瞻性数据库进行分析，以确定组织学证实的胰腺导管腺癌患者。排除壶腹肿瘤、胆管细胞癌、十二指肠腺癌和神经内分泌肿瘤。对这些患者的组织学报告进行复习。进行单因素和多因素生存分析，以确定可用于预测长期预后的变量。结果：134例胰腺导管腺癌患者接受了胰腺十二指肠切除术。本组5年生存率为18.6%。单变量分析确定淋巴结状态和转移与切除的淋巴结比率是生存的预测因素。通过多变量COX回归分析，转移率为15%(P<；0.01)和有无神经侵袭(P<；0.05)是患者生存的独立预测因素。转移率和切除率能更好地对预后进行分层，无病变者5年生存率为55.6%，NI病者为12.9%。而15%结节阳性者的转移率为5.2%(P=0.0017)。结论：对胰腺导管癌术后淋巴结阳性的患者，淋巴结转移与切除率的比值可提供有意义的预后信息。(C)2011爱思唯尔有限公司。保留所有权利。
Background: Overall five year survival following pancreaticoduodenectomy for ductal adenocarcinoma is poor with typical reported rates in the literature of 8-27%. The aim of this study was to identify the histological variables best able to predict long-term survival in these patients.Methods: A prospective database of patients undergoing pancreaticoduodenectomy between April 2002 and June 2009 was analysed to identify patients with histologically proven pancreatic ductal adenocarcinoma. Patients with ampullary tumours, cholangiocarcinoma, duodenal adenocarcinoma and neuroendocrine tumours were excluded. The histology reports for these patients were reviewed. Uni-variate and multi-variate survival analysis was performed to identify variables useful in predicting long-term outcome.Results: 134 patients underwent pancreaticoduodenectomy for pancreatic ductal adenocarcinoma during this period. 5 year survival in this series was 18.6%. Uni-variate analysis identified nodal status and the metastatic to resected lymph node ratio as predictors of survival. Using multi-variate Cox Regression analysis a metastatic to lymph node ratio of >15% (p < 0.01) and the presence of perineural invasion (p < 0.05) were identified as independent predictors of patient survival. Metastatic to resected lymph node ratio is better able to stratify prognosis than nodal status alone with 5 year survival of those with NO disease being 55.6% and 12.9% for NI disease. However for those with 15% nodes positive it was 5.2% (p = 0.0017).Conclusion: The metastatic to resected lymph node ratio can provide significant prognostic information in those patients with node positive disease after pancreaticoduodenectomy for pancreatic ductal adenocarcinoma. (C) 2011 Elsevier Ltd. All rights reserved.