中国实用外科杂志

中国实用外科杂志

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基于淋巴结分期评分的胰腺癌手术淋巴结清扫数目探讨（附四中心临床研究结果）

任    泰1，郭世伟2，王伟珅3，王单松4，王    铮1，杨    洋1，邵子雨1，赵安达5，束翌俊1，王许安1，李生慧5，张    熙6，金    钢2，沈柏用3，楼文晖4，刘颖斌1   

  1. 1上海交通大学医学院附属新华医院普外科  上海市胆道疾病研究重点实验室  上海市胆道疾病研究中心，上海 200092；2 海军军医大学第一附属医院胰腺外科，上海 200082； 3 上海交通大学医学院附属瑞金医院胰腺外科，上海200020；4 复旦大学附属中山医院普外科，上海 200032；5 上海交通大学医学院公共卫生学院，上海200025；6 上海交通大学医学院附属新华医院临床研究中心，上海 200092
  • 出版日期:2019-06-01 发布日期:2019-06-12

  • Online:2019-06-01 Published:2019-06-12

摘要：

目的    探讨胰腺癌淋巴结准确分期所需清扫的淋巴结数目。方法    回顾性分析美国SEER数据库中3989例切除的胰腺癌淋巴结阳性病人资料并进行建模，得到淋巴结分期评分达到90%时所需的淋巴结清扫数目作为推荐值，并利用SEER数据库2583例与国内93例淋巴结阴性病人进行生存分析验证结果。结果    肿瘤最大径＜2 cm是胰腺癌淋巴结清扫数量的影响因素。预期对阴性结果达到90%把握时，肿瘤最大径＜2 cm的病人需要活检15枚淋巴结，而≥2 cm的病人需要活检20枚。校正假阴性病人后，淋巴结阳性率从60.7%升至71.0%。生存分析提示肿瘤最大径≥2 cm病人中，淋巴结分期评分与生存有相关性（P=0.002）。结论    肿瘤最大径是决定胰腺癌淋巴结清扫数量的因素。根据淋巴结分期评分，推荐清扫更多淋巴结。

关键词: 胰腺癌, 肿瘤分期, 淋巴结, 假阴性率

Abstract:

The adequate number of lymph node dissection in pancreatic cancer radical surgery based on nodal staging score(with four-center cohort validation)        REN Tai*, GUO Shi-wei, WANG Wei-shen, et al.  *Department of General Surgery, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine; Shanghai Key Laboratory of Biliary Tract Disease Research，Shanghai 200092, China
Corresponding authors: LIU Ying-bin, E-mail：liuyingbin@xinhuamed.com.cn; JIN Gang, E-mail：jingang@sohu.com; SHEN Bai-yong, E-mail：shenby@shsmu.edu.cn; LOU Wen-hui: lou.wenhui@zs-hospital.sh.cn; ZHANG Xi, E-mail：zhangxi@xinhuamed.com.cn
Abstract    Objective    To estimate the number of lymph nodes （LNs） needed to be examined for adequate LN staging via nodal staging score（NSS）.Methods  A model was fitted based on 3989 pN+ patients with resected primary pancreatic adenocarcinoma in the Surveillance，Epidemiology and End Results（SEER） database.The number of nodes to examine to achieve an NSS of 90% was used as the optimal number.The results were validated in node negative patients from the SEER cohort （2583 patients） and a local multicenter cohort （93 patients）.Results    Tumor size is a determinant for the extent of lymphadenectomy.According to the tumor size ＜ 2 cm and ≥2 cm，15 and 20 LNs would need to be examined to achieve 90% confidence in a pN0 patient.As a result of missing node-positive case，the prevalence of node-positive was adjusted from 60.7% to 71.0%.In the survival analysis，more LNs examined was shown to be correlated with better prognosis in patients with tumor ≥2 cm.Conclusion    The minimum number of LNs for adequate staging depends on the tumor size.The estimation provides a practical standard for evaluating the extent of LN yield for surgeons.

Key words: pancreatic cancer, tumor stage, lymph node, false-negative rate