Defining a minimum number of examined lymph nodes improves the prognostic value of lymphadenectomy in pancreas ductal adenocarcinoma
Defining a minimum number of examined lymph nodes improves the prognostic value of lymphadenectomy in pancreas ductal adenocarcinoma
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DOI：
10.1016/j.hpb.2020.08.016
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发表时间：
2021-03-26
期刊：
影响因子：
2.9
通讯作者：
Burkhart, Richard A.
中科院分区：
文献类型：
--
作者：
Pu, Ning;Gao, Shanshan;Burkhart, Richard A.
背景：胰腺导管腺癌（PDAC）切除术后淋巴结（LN）转移与生存率降低相关。在N0疾病中，增加总评估LN（ELN）与改善的结局相关，表明当LN采样不足时，患者可能分期不足。我们的目的是评估最佳数量的检查淋巴结（ELN）以下pancreatectics.Methods：从1837例接受手术的患者的数据进行了前瞻性收集。采用二项概率法分析检查LN的最小数量（minELN），并准确表征每个组织病理学阶段。结果：随着ELN总数的增加，发现淋巴结阳性疾病的可能性增加。根据二项式概率定律进行的评估表明，准确的AJCC N分期的最佳最小ELN为12。随着ELN数量的增加，替代策略的判别能力，以表征LN疾病超过AJCC N stage.Conclusion提供的：这是第一项研究，致力于优化组织病理分期PDAC使用模型的minELN通知二项式概率法。本研究强调了ELN的两个独立的截止值取决于预后目标，并验证了12个LN足以确定大多数患者的AJCC N分期。
Background: Lymph node (LN) metastasis is associated with decreased survival following resection for pancreatic ductal adenocarcinoma (PDAC). In N0 disease, increasing total evaluated LN (ELN) correlates with improved outcomes suggesting patients may be understaged when LNs are undersampled. We aim to assess the optimal number of examined lymph nodes (ELN) following pancreatectomy.Methods: Data from 1837 patients undergoing surgery were prospectively collected. The binomial probability law was utilized to analyze the minimum number of examined LNs (minELN) and accurately characterize each histopathologic stage. LN ratio (LNR) was compared to American Joint Committee on Cancer (AJCC) guidelines.Results: As ELN total increased, the likelihood of finding node positive disease increased. An evaluation based upon the binomial probability law suggested an optimal minELN of 12 for accurate AJCC N staging. As the number of ELNs increased, the discriminatory capacity of alternative strategies to characterize LN disease exceeded that offered by AJCC N stage.Conclusion: This is the first study dedicated to optimizing histopathologic staging in PDAC using models of minELN informed by the binomial probability law. This study highlights two separate cutoffs for ELNs depending upon prognostic goal and validates that 12 LNs are adequate to determine AJCC N stage for the majority of patients.