淋巴结转移率是胰头恶性肿瘤术后独立的预后影响因素  

Lymph node ratio is an independent prognostic factor after resection of pancreatic head cancer

作　　者：杨宇尘 詹茜 沈柏用[1] 

机构地区：[1]上海交通大学医学院附属瑞金医院外科上海交通大学医学院胰腺疾病研究所,上海200025

出　　处：《外科理论与实践》2015年第6期490-495,共6页Journal of Surgery Concepts & Practice

基　　金：上海申康医院发展中心2015年新兴前沿技术项目(SHDC12015109)

摘　　要：目的 :研究胰头恶性肿瘤行胰十二指肠切除术后,淋巴结转移数及淋巴结转移率(lymph node ratio,LNR)对生存时间的影响。方法:151例病人因胰头导管腺癌行胰十二指肠切除术,应用单因素及多因素分析的方法研究比较临床病理学因素对预后的影响,包括淋巴结转移数及LNR。结果:病人1、2年总生存率分别为70.3%和49.7%,5年78例总生存率15.4%。平均淋巴结检测数目为(7.4±5.7)枚,平均阳性淋巴结数目为(0.9±1.7)枚。在单因素分析中,发现有无淋巴结转移,LNR≥0.1,TNM分期p T和总分期均影响术后5年生存率(P<0.05)。在多因素分析中,有无淋巴结转移,与LNR≥0.1都独立地与5年生存时间有关。生存曲线分析中,LNR≥0.1(P=0.03),LNR≥0.2(P=0.016),显著影响病人的生存时间。结论 :相比于淋巴结转移数,LNR对胰头恶性肿瘤行胰十二指肠切除术后病人生存的预测更有意义。Objective To evaluate the prognostic effect on the survival of patients with pancreatic head cancer using the number of metastatic lymph nodes and the ratio of metastatic lymph nodes to total number of examined nodes （lymph node ratio, LNR） from pancreatoduodenectomy. Methods Totally 151 consecutive patients with pancreatic ductal adenocar-cinoma in pancreatic head, who underwent pancreaticoduodenectomy, were reviewed retrospectively. Clinicopathologic fac-tors including number of metastatic nodes and LNR, and survival were analyzed for the prognostic effect by univariate and multivariate analyses. Results Overall survival rates were 70.3% and 49.7%, at 1, 2 years, respectively and the survival rate at 5 years of 78 cases was 15.4%. The mean numbers of evaluated lymph nodes and involved nodes were 7.4 ±5.7 and 0.9±1.7 respectively. Univariate analysis revealed that positive lymph node, LNR≥0.1, pT factor, and tumor stage corre-lated significantly （P〈0.05） with 5 year survival. By multivariate analysis, positive lymph node and LNR≥0.1 correlated in-dependently with 5 year survival. LNR≥0.1 （P=0.03）, LNR≥0.2 （P=0.016）correlated with 5 year survival during the analysis of survival curves. Conclusions LNR has much more powerful prognostic effect than number of metastatic nodes on the survival of patients with pancreatic head cancer after pancreatioduodenectomy.

关 键 词：胰腺恶性肿瘤 淋巴结清扫 胰十二指肠切除术 淋巴结转移率 

分 类 号：R735.9[医药卫生—肿瘤]