Pattern of Lymph Node Metastasis Spread in Pancreatic Cancer
Pattern of Lymph Node Metastasis Spread in Pancreatic Cancer
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DOI：
10.1097/mpa.0b013e3182148342
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发表时间：
2011-08-01
期刊：
影响因子：
2.9
通讯作者：
Nakao, Akimasa
中科院分区：
文献类型：
--
作者：
Kanda, Mitsuro;Fujii, Tsutomu;Nakao, Akimasa
目的：我们的目的是阐明胰腺癌患者淋巴结（LN）转移的详细模式。方法：这项回顾性研究纳入了 429 例接受胰腺癌扩大淋巴结切除术的患者。评估LN转移的预后意义，并调查其位置、频率以及与其他临床病理因素的关联。结果：289例患者（67.4%）经病理证实淋巴结转移。有淋巴结转移的患者预后明显差于无淋巴结转移的患者（P G<0.001）。无论肿瘤部位如何，远处淋巴结转移都经常发生。 T1或T2阶段的患者仅出现局部淋巴结转移，而T3或更高阶段的肿瘤患者则远处淋巴结转移（包括主动脉旁淋巴结）的发生率很高。主动脉旁淋巴结转移与动脉和神经周围浸润显着相关（分别为 P = 0.006 和 P < 0.001）。肝门区淋巴结转移是胰头癌主动脉旁淋巴结转移的有力预测因素。结论：胰腺癌经常通过复杂的途径转移至远处淋巴结并发展为全身性疾病。积极的多学科治疗，包括新辅助治疗，对于改善存在远处淋巴结转移风险的患者的长期生存至关重要。
Objectives: We aimed to clarify the detailed pattern of lymph node (LN) metastasis spread in patients with pancreatic cancer.Methods: This retrospective study enrolled 429 patients who underwent pancreatectomy with extended lymphadenectomy for pancreatic cancer. The prognostic implications of LN metastasis were evaluated, and the position, frequency, and association with other clinicopathologic factors were investigated.Results: Lymph node metastasis was confirmed pathologically in 289 patients (67.4%). The prognosis of patients with LN metastasis was significantly poorer than that of patients without LN metastasis (P G 0.001). Distant LN metastasis occurred frequently, regardless of the tumor site. Patients classified with T1 or T2 only had regional LN metastasis, whereas there was a high rate of distant LN metastasis, including the para-aortic LNs, in patients with T3 or higher-stage tumors. Paraaortic LN metastasis was significantly associated with arterial and perineural invasion (P = 0.006 and P < 0.001, respectively). Lymph node metastasis in the hepatic portal region was a strong predictor of para-aortic LN metastasis in pancreatic head cancer.Conclusions: Pancreatic cancer frequently metastasized to distant LNs via a complex pathway and developed into systemic disease. Aggressive multimodality therapy, including neoadjuvant therapy, is essential to improve the long-term survival of patients at substantial risk of distant LN metastasis.