胰腺癌临床病理特征与淋巴结转移的关系

Analysis of the relationship between clinicopathological factors and lymph node matastasis of pancreatic adenocarcinoma

目的研究胰腺癌的临床病理特征与淋巴结转移的关系。方法回顾性分析71例手术切除的胰腺癌患者-降别、年龄、术前CA-19-9水平、血型、肿瘤部位、分化程度、肿瘤最大径、侵犯范围和脉管瘤栓等临床病理资料，分析其与淋巴结转移的关系。结果71例患者全部行根治性切除术，其中胰十二指肠切除术45例，胰体尾加脾切除术26例。71例患者中，淋巴结转移36例（50．7％）。共检出淋巴结979枚，平均13．8枚／例；其中阳性淋巴结90枚，平均2．5枚／例。单因素分析显示，胰腺癌的分化程度与侵犯范围与淋巴结转移有关（P〈0．05）。Logistic回归多因素分析显示，肿瘤分化程度低和侵犯胰腺外组织可增加胰腺癌淋巴结转移风险（P〈0．05）。结论胰腺癌的分化程度和侵犯范围与淋巴结转移密切相关，而患者性别、年龄、术前CA-19-9水平、血型、肿瘤部位、肿瘤最大径和脉管瘤栓与淋巴结转移无关。因此，对于术中判断肿瘤分化程度低和侵犯胰腺外组织的患者，应重视淋巴结的清扫。

Objective To investigate retrospectively the relationship between clinicopathological factors and lymph node matastasis of pancreatic adenocarcinoma. Methods The clinicopathologieal factors, including gender, age, preoperative CA-19-9 level etc. of 71 patients with pancreatic ade summarized to analyze the relationship between those factors and lymph node matastasis. Results Among the 71 cases, there were 49 males （69.0%） and 22 females （31.0%）. Forty-eight were t〉60 （67.6%） and 23 were 〈60 （32.4%） years old. Twenty patients had normal preoperative CA-19-9 level （28.2%） and 51 had elevated level （71.8%）. The tumor in 43 （60.6%） cases located in the pancreatic head and neck, and 28 （39.4%） in the body and tail. The tumors in 8 patients were well-differentiated （ 11.3% ）, 27 were moderately differentiated （38.0%）, and 36 were poorly differentiated （50.7%）. The maximum diameter of the tumor was ~〈2 em in 11 eases （15.5%）,2-5 em in 45 cases （63.4%）, and 〉5 em in 15 cases （21.1%）. Ten patients had tumor confined to the pancreas （ 14. 1% ）, and 61 invaded peripanereatic tissues （85.9%）. Vascular tumor thrombus was found in 48 cases （67.6%）, and 23 cases were absent （32. 4% ）. Thirty-six cases had lymph node matastasis （50. 7% ）. Univariate chi-square test revealed that differentiation and range of local infiltration were significantly associated with lymph node meatstasis （P 〈 0.05）. Multivariate logistic regression analysis also showed that differentiation and range of local infiltration were significantly associated with lymph node meatstasis （P 〈 0.05）. Conclusions The differentiation of tumor and range of local infiltration of pancreatic adenocarcinoma are significantly associated with lymph node metastasis. There is no significant relationship of location of the tumor, maximum diameter, presence or absence of vascular tumor thrombus with lymph node metastasis. Therefore, special attention should be paid to lymph node dissection in cases with a poorly differentiated pancreatic adenocarcinoma invading into peripancreatic tissues.