Patterns and prognostic value of lymph node dissection for resected perihilar cholangiocarcinoma.
Patterns and prognostic value of lymph node dissection for resected perihilar cholangiocarcinoma.
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切除的肝门周围胆管癌淋巴结清扫的模式和预后价值。
DOI：
10.1111/jgh.13072
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发表时间：
2016-02
影响因子：
4.1
通讯作者：
Wang J
中科院分区：
文献类型：
--
作者：
Mao K;Liu J;Sun J;Zhang J;Chen J;Pawlik TM;Jacobs LK;Xiao Z;Wang J
淋巴结转移是影响肝门部胆管癌预后的主要因素。然而，淋巴结清扫范围、淋巴结比率（LNR）、阳性淋巴结的数量和位置的预后意义尚不清楚。我们的目的是评估淋巴结状态、LNR、阳性淋巴结的数量或位置是否是PHC分期的独立因素，并确定淋巴结检查的最低要求。监测，流行病学和最终结果数据库用于确定1998年至2008年期间切除的1，116例PHCs。回顾性分析淋巴结状态与生存率的相关性。43.4%的患者发生淋巴结转移，淋巴结转移是总生存期（OS）和癌症特异性生存期（CSS）的独立预测因素。在淋巴结阳性患者中，没有观察到淋巴结回收数量增加的生存益处。然而，在淋巴结阴性患者中，≥13个淋巴结清扫比3≤总淋巴结计数（TLNC）≤12和TLNC<3具有更大的生存获益（5年OS：52.8% vs. 39.7% vs. 26.3%，P=0.001; 5年CSS：60.6% vs. 46.3% vs. 30.0%，P=0.001）。区域淋巴结转移与远处淋巴结转移患者的生存率无差异，>3个阳性淋巴结者的生存率明显低于3个或3个以下者（RR：1.466，P=0.001）。LNR>0.27者预后不良（RR：1.376：，P=0.001）。为了充分评估这种危及生命的疾病的淋巴结状态，应考虑取出13个或更多个淋巴结。阳性淋巴结数目和淋巴结转移率可作为原发性肝癌分期的参考指标，而转移淋巴结的位置则不一定。
Lymph node metastasis is a major prognostic factor for perihilar cholangiocarcinoma (PHC). However, prognostic significance of extent of node dissection, lymph node ratio (LNR), number and location of positive nodes remain unclear. We aimed to evaluate whether node status, LNR, number or location of positive nodes are independent factors for staging in PHC, and to determine the minimum requirements for node examination. The Surveillance, Epidemiology, and End Results database was used to identify 1,116 resected PHCs from 1998 to 2008. The correlation between nodal status and survival was analyzed retrospectively. Lymph node metastasis occurred in 43.4% patients and was an independent predictor for overall survival (OS) and cancer-specific survival (CSS). No survival benefit was observed for an increasing number of node retrieval in node-positive patients. However, in node-negative patients, ≥13 node dissection was of more survival benefit than 3≤total lymph node count (TLNC) ≤12 and TLNC<3 (5-year OS: 52.8% vs. 39.7% vs. 26.3%, P=0.001; 5-year CSS: 60.6% vs. 46.3% vs. 30.0%, P=0.001). No difference in survival between patients with regional and distant node involvement was found. Survival for patients with >3 positive nodes was significantly worse than that for those with 3 or less (RR: 1.466, P=0.001). And patients with LNR>0.27 also had unfavorable prognosis (RR: 1.376:, P=0.001). To adequately assess nodal status of this life-threatening disease, 13 or more nodes retrieval should be considered. Number of positive nodes and LNR rather than location of metastatic nodes may be defined as parameters for staging of PHC.