胰腺浸润性导管内乳头状黏液性癌：生存预测因素和淋巴结比率的作用。
Invasive intraductal papillary mucinous carcinomas of the pancreas: predictors of survival and the role of lymph node ratio.
机构信息
Department of Surgery, University of Verona, Verona, Italy.
出版信息
Ann Surg. 2010 Mar;251(3):477-82. doi: 10.1097/SLA.0b013e3181cf9155.
INTRODUCTION
Intraductal papillary mucinous neoplasms (IPMNs) are being increasingly recognized, and often harbor cancer. Lymph node metastases are an important prognostic factor for patients with invasive intraductal papillary carcinoma (I-IPMC), but the role of lymph node ratio (LNR) in predicting survival after surgery for I-IPMC is unknown.
METHODS
The combined databases from the Surgical Department of Massachusetts General Hospital of Boston and the University of Verona were queried. We retrospectively reviewed clinical and pathologic data of all patients with resected, pathologically confirmed, I-IPMC between 1990 and 2007. Univariate and multivariate analysis were performed.
RESULTS
I-IPMCs were diagnosed in 104 patients (55 males and 49 females), median age was 69 years. Recurrent disease was identified in 49 patients (47.1%) and the median 5-year disease specific survival (DSS) was 60.1%. The median number of resected/evaluated nodes was 15 (range, 5-60). There were 60 (57.7%) patients who had negative lymph nodes (N0), whereas 44 (42.3%) had lymph node metastases (N1). Patients with lymph node metastases had a shorter 5-year DSS (28.9%) compared with patients with negative lymph nodes (80.3%; P < 0.05) As the LNR increased, 5-year DSS decreased (LNR = 0, 86.5%; LNR >0 to 0.2, 34.4%; LNR >0.2, 11.1%; P < 0.05). On multivariate analysis, LNR, the presence of a family history of pancreatic cancer and a preoperative value of Ca 19.9 > 37 U/L were significant predictors of survival (P < 0.05).
CONCLUSIONS
Lymph node ratio is a strong predictor of survival after resection for invasive intraductal papillary mucinous carcinoma.
简介
导管内乳头状黏液性肿瘤（IPMNs）的发病率越来越高，且常伴有癌症。淋巴结转移是浸润性导管内乳头状癌（I-IPMC）患者的一个重要预后因素，但淋巴结比率（LNR）在预测 I-IPMC 手术后生存情况中的作用尚不清楚。
方法
我们检索了波士顿马萨诸塞州综合医院外科部门和维罗纳大学的联合数据库。回顾性分析了 1990 年至 2007 年间经手术切除并经病理证实的 I-IPMC 患者的临床和病理资料。进行了单因素和多因素分析。
结果
诊断为 I-IPMC 的患者有 104 例（55 例男性和 49 例女性），中位年龄为 69 岁。49 例（47.1%）患者出现复发病例，中位 5 年疾病特异性生存率（DSS）为 60.1%。切除/评估的淋巴结中位数为 15 个（范围为 5-60 个）。60 例（57.7%）患者为淋巴结阴性（N0），44 例（42.3%）为淋巴结转移（N1）。淋巴结转移患者的 5 年 DSS 明显较短（28.9%），而淋巴结阴性患者的 5 年 DSS 较长（80.3%；P < 0.05）。随着 LNR 的增加，5 年 DSS 降低（LNR = 0，86.5%；LNR >0 至 0.2，34.4%；LNR >0.2，11.1%；P < 0.05）。多因素分析显示，LNR、家族性胰腺癌病史和术前 CA 19.9 值>37 U/L 是生存的显著预测因素（P < 0.05）。
结论
淋巴结比率是预测浸润性导管内乳头状黏液性癌切除后生存情况的一个强有力的预测因子。
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