Comparison of Number Versus Ratio of Positive Lymph Nodes in the Assessment of Lymph Node Status in Extrahepatic Cholangiocarcinoma
Comparison of Number Versus Ratio of Positive Lymph Nodes in the Assessment of Lymph Node Status in Extrahepatic Cholangiocarcinoma
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DOI：
10.1245/s10434-015-4609-x
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发表时间：
2016-01-01
影响因子：
3.7
通讯作者：
Ajioka, Yoichi
中科院分区：
文献类型：
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作者：
Sakata, Jun;Wakai, Toshifumi;Ajioka, Yoichi
为比较肝外胆管癌根治术后阳性淋巴结数与淋巴结比率（LNR）对术后生存的预测价值，对142例肝外胆管癌根治术后患者的临床资料进行回顾性分析。共切除区域淋巴结3066个。每例患者的中位淋巴结数量为21。采用考克斯比例风险回归模型计算卡方积分，确定阳性淋巴结数和LNR的最佳截止值。在随后的淋巴结状态对生存率的影响分析中，排除了18例R1/2切除术患者和6例切除术后生存时间不超过5年的主动脉旁淋巴结疾病患者。阳性节点数的最佳截止值为1，LNR的最佳截止值为5%。单变量分析确定阳性淋巴结数量（0、1或千分之一; P = 0.005）和LNR（0、0-5或> 5%; P = 0.007）是重要的预后因素。多因素分析表明，阳性淋巴结数量是独立的预后因素（P = 0.012），而LNR不是。无阳性淋巴结者的5年生存率为64%，有1个阳性淋巴结者为46%，有2个或2个以上阳性淋巴结者为28%，阳性淋巴结数比LNR更能预测肝外胆管癌切除后的生存率，前提是淋巴结评估充分。
This study aimed to compare the utility of the number of positive lymph nodes with the lymph node ratio (LNR) in predicting survival after resection of extrahepatic cholangiocarcinoma.A retrospective analysis of 142 consecutive patients who underwent radical resection of extrahepatic cholangiocarcinoma was performed. A total of 3066 regional lymph nodes were resected. The median number of nodes per patient was 21. The optimal cutoff values for the number of positive nodes and the LNR were determined using the Chi square scores calculated by the Cox proportional hazards regression model.Nodal disease was found in 59 patients (42 %). In the subsequent analysis of the impact that nodal status has on survival, 18 patients with R1/2 resection and 6 patients with paraaortic nodal disease who did not survive for more than 5 years after resection were excluded. The optimal cutoff value for the number of positive nodes was 1, and the optimal cutoff value for the LNR was 5 %. Univariate analysis identified both the number of positive nodes (0, 1, or a parts per thousand yen2; P = 0.005) and the LNR (0, 0-5, or > 5 %; P = 0.007) as significant prognostic factors. Multivariate analysis identified the number of positive nodes but not the LNR as an independent prognostic factor (P = 0.012). The 5-year survival rates were 64 % for the patients with no positive nodes, 46 % for the patients with one positive node, and 28 % for the patients with two or more positive nodes.The number of positive lymph nodes predicts survival better than the LNR after resection of extrahepatic cholangiocarcinoma, provided that nodal evaluation is sufficient.