Prognostic relevance of lymph node ratio following pancreaticoduodenectomy for pancreatic cancer
Prognostic relevance of lymph node ratio following pancreaticoduodenectomy for pancreatic cancer
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DOI：
10.1016/j.surg.2006.12.013
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发表时间：
2007-05-01
期刊：
影响因子：
3.8
通讯作者：
Choti, Michael A.
中科院分区：
文献类型：
--
作者：
Pawlik, Timothy M.;Gleisner, Ana L.;Choti, Michael A.
背景。已知淋巴结转移的存在或不存在是胰腺癌患者的重要预后因素。很少有研究调查含有转移癌的淋巴结数量与检查的淋巴结总数的比率（淋巴结比率 [LNR]）与胰腺导管癌胰十二指肠切除术后的结果有关。方法。 1995年至2005年间，共有905名患者因胰腺癌接受了胰十二指肠切除术。分析了人口统计学、手术数据、评估的淋巴结数量、转移癌淋巴结数量、LNR 病理边缘状态和长期生存率。结果。 905 例患者中有 187 例（20.7%）胰周淋巴结阴性（N0），而 905 例患者中有 718 例（79.3%）有淋巴结转移（N1）。 N0 组评估的淋巴结中位数为 15 个，而 N1 组评估的淋巴结中位数为 18 个 (P = .12)。中位随访 24 个月时，所有患者的中位生存期为 17.4 个月，5 年精算生存率为 16.1%。与淋巴结阴性患者（25.3 个月；P = .001）相比，有淋巴结转移的患者的中位总生存期较短（16.5 个月）。与检查的淋巴结总数或淋巴结转移总数相比，LNR 是最引人注目的生存预测因子。随着 LNR 的增加，中位总生存期下降（LNR = 0，25.3 个月；LNR > 0 至 0.2，21.7 个月；LNR > 0.2 至 0.4，15.3 个月；LNR > 0.4，12.2 个月；P = 0.001）。在调整与生存相关的其他因素后，LNR 仍然是总生存的独立预测因子 (P < .001)。结论。胰腺癌胰十二指肠切除术后，LNR 是最有力的生存预测因子之一。在未来的临床试验中对患者进行分层时应考虑 LNR。
Background. The presence or absence of lymph node metastases is known to be an important Prognostic factor for patients with pancreatic cancer. Few studies have investigated the ratio of the number of lymph nodes harboring metastatic cancer to the total number of lymph nodes examined (lymph node ratio [LNR]) with regard to outcome after pancreaticoduodenectomy for ductal cancer of the pancreas.Methods. Between 1995 and 2005, a total of 905 patients underwent Pancreaticoduodenectomy for pancreatic adenocarcinoma. Demographics, operative data, number of lymph nodes evaluated, number of lymph nodes with metastatic carcinoma, LNR pathologic margin status, and long-term survival were analyzed.Results. There were 187 (20.7%) of the 905 patients who had negative peripancreatic lymph nodes (N0), whereas 718 (79.3%) of the 905 patients had lymph node metastases (N1). The median number of lymph nodes evaluated in the N0 group was 15 versus 18 in the N1 group (P = .12). At median follow-up of 24 months, the median survival for all patients was 17.4 months, and the 5-year actuarial survival rate was 16.1%. Patients with lymph node metastases had a shorter median overall survival (16.5 months) compared with patients with negative lymph nodes (25.3 months; P = .001). Compared with the total number of lymph nodes examined or total number of lymph node metastases, LNR was the most compelling predictor of survival. As the LNR increased, median overall survival decreased (LNR = 0, 25.3 months; LNR > 0 to 0.2, 21.7 months; LNR > 0.2 to 0.4, 15.3 months; LNR > 0.4, 12.2 months; P = .001). After adjusting for other factors associated with survival, LNR remained an independent predictor of overall survival (P < .001).Conclusions. After pancreaticoduodenectomy for adenocarcinoma of the pancreas, LNR was one of the most powerful predictors of survival. LNR should be considered when stratifying patients in future clinical trials.