Abstract：
BACKGROUND: The nodal stage of pancreatic ductal adenocarcinoma (PDAC) is revised in the AJCC 8th edition. Studies on the prognosis of PDAC according to lymph node metastasis (LNM) are still ongoing. We attempted to find the patterns of nodal involvement and to reveal its clinical significance to overall survival (OS).
METHODS: We analyzed 585 patients who received pancreatic head cancer surgery diagnosed as PDAC from January 2007 to December 2016. Patients were classified into three groups: Group 1 (G1, patients without LNM), Group 2 (G2, those with LNM only in the peripancreatic area), and Group 3 (G3 those with LNM in the other area and/or peripancreatic LNM). Risk factors were analyzed by Cox-regression test and overall survival was compared by Kaplan-Meier analysis.
RESULTS: LNM in peripancreatic area was the most common (88.7%). In the multivariate analysis, T stage, nuclear differentiation, adjuvant treatment, and the G2 and G3 were independent risk factors for OS (G2 over G1, HR 1.384, 95% CI 1.046-1.802; P = .036 and G3 over G1, HR 2.383, 95% CI 1.378-4.103; P = .001). G3 showed worse OS than G2 (P = .006). In the N1 status, LNM to the pericholedochal (PC) and superior mesenteric artery (SMA) areas resulted in worse OS than the G2 (P = .011 and P = .019).
CONCLUSIONS: We found that LNM beyond the peripancreatic area significantly affects OS in pancreatic head cancer patients. Depending on the station of the LNM, different risk-stratification and treatment strategies will need to be considered.
METHODS: We analyzed 585 patients who received pancreatic head cancer surgery diagnosed as PDAC from January 2007 to December 2016. Patients were classified into three groups: Group 1 (G1, patients without LNM), Group 2 (G2, those with LNM only in the peripancreatic area), and Group 3 (G3 those with LNM in the other area and/or peripancreatic LNM). Risk factors were analyzed by Cox-regression test and overall survival was compared by Kaplan-Meier analysis.
RESULTS: LNM in peripancreatic area was the most common (88.7%). In the multivariate analysis, T stage, nuclear differentiation, adjuvant treatment, and the G2 and G3 were independent risk factors for OS (G2 over G1, HR 1.384, 95% CI 1.046-1.802; P = .036 and G3 over G1, HR 2.383, 95% CI 1.378-4.103; P = .001). G3 showed worse OS than G2 (P = .006). In the N1 status, LNM to the pericholedochal (PC) and superior mesenteric artery (SMA) areas resulted in worse OS than the G2 (P = .011 and P = .019).
CONCLUSIONS: We found that LNM beyond the peripancreatic area significantly affects OS in pancreatic head cancer patients. Depending on the station of the LNM, different risk-stratification and treatment strategies will need to be considered.
摘要：
背景：胰腺导管腺癌（PDAC）的淋巴结分期在AJCC第8版中进行了修订。根据淋巴结转移（LNM）对PDAC预后的研究仍在进行中。我们试图找到淋巴结受累的模式，并揭示其对总生存期（OS）的临床意义。
方法：我们分析了2007年1月至2016年12月接受胰头癌手术诊断为PDAC的585例患者。患者分为三组：第1组（G1，无LNM患者），第2组（G2，仅在胰周区域具有LNM的那些），和第3组（其他区域和/或胰周LNM的G3）。采用Cox回归检验分析危险因素,采用Kaplan-Meier分析比较总生存期。
结果：胰周区域的LNM最为常见（88.7%）。在多变量分析中，T级,核分化，辅助治疗,G2和G3是OS的独立危险因素（G2超过G1，HR1.384，95％CI1.046-1.802；P=.036，G3超过G1，HR2.383，95％CI1.378-4.103；P=.001）。G3表现出比G2更差的OS(P=.006)。在N1状态下,LNM到胆囊周围（PC）和肠系膜上动脉（SMA）区域导致OS比G2差（P=.011和P=.019）。
结论：我们发现胰周区域以外的LNM显著影响胰头癌患者的OS。根据LNM的位置，需要考虑不同的风险分层和治疗策略.
方法：我们分析了2007年1月至2016年12月接受胰头癌手术诊断为PDAC的585例患者。患者分为三组：第1组（G1，无LNM患者），第2组（G2，仅在胰周区域具有LNM的那些），和第3组（其他区域和/或胰周LNM的G3）。采用Cox回归检验分析危险因素,采用Kaplan-Meier分析比较总生存期。
结果：胰周区域的LNM最为常见（88.7%）。在多变量分析中，T级,核分化，辅助治疗,G2和G3是OS的独立危险因素（G2超过G1，HR1.384，95％CI1.046-1.802；P=.036，G3超过G1，HR2.383，95％CI1.378-4.103；P=.001）。G3表现出比G2更差的OS(P=.006)。在N1状态下,LNM到胆囊周围（PC）和肠系膜上动脉（SMA）区域导致OS比G2差（P=.011和P=.019）。
结论：我们发现胰周区域以外的LNM显著影响胰头癌患者的OS。根据LNM的位置，需要考虑不同的风险分层和治疗策略.
