胰腺癌淋巴结转移情况与预后关系的研究探讨

Prognosis impact of lymph nodes metastasis in pancreatic cancer

目的探讨胰腺癌淋巴结转移情况对预后的影响。方法回顾性分析2009年1月至2012年12月收治的65例接受胰十二指肠切除术的胰腺癌患者的临床资料,对是否有淋巴结转移、淋巴结清扫数、淋巴结阳性数、淋巴结阳性比率(LNR)等因素分别进行分组分析。生存率采用log-rank检验,采用COX风险回归模型进行多因素分析。结果58例获取随访患者6个月、1年、3年生存率分别为91.0%,74.8%,21.7%,中位生存期14.1个月。单因素分析显示:是否有淋巴结转移、淋巴结转移比率对中位生存期的影响差异有统计学意义(P<0.05),LNR≤0.2较>0.2预后好。在无淋巴结转移组(pN0)中,淋巴结清扫数增多能够显著改善预后(P<0.05),而在淋巴结转移组(pN1)中,淋巴结转移数对于预后无显著影响。对于pN1患者行多因素分析提示:侵透胰腺被膜、LNR是影响预后的独立因素。结论胰腺癌淋巴结转移情况与预后密切相关,淋巴结清扫数在pN0患者能够影响胰腺癌的预后。LNR>0.2是预后的独立影响因素。

Objective To explore the prognosis impact of lymph nodes metastasis in pancreatic cancer. Methods The clinical data of 65 patients with pancreatic cancer who underwent radial panereatectomy from January 2009 to September 2012 were analyzed retrospectively. Patients were categorized into different groups by lymph nodes metastasis status, count of lymph nodes examined, count of positive lymph nodes and lymph nodes ratio （LNR）. Log - rank test and Cox proportional hazard models were used to evaluate the prognostic effect. Results Median survival for the overall 58 patients receiving follow - up was 14.1 months with 6 - months, 1 - year and 3 - years survival rate of 91.0% ,74.8% and 21.7% respectively. Univariate analysis showed that there was significant difference in the median survival between the patients with and without lymph nodes metastasis ,and patients with LNR ~〈0.2 had better prognosis than those with LNR 〉0.2 （ P 〈0.05 ）. The count of lymph nodes examined was related to the survival significantly in nodes - negative patients （ P 〈 0.05 ）, whereas in nodes - positive patients the count of lymph nodes had no effect on survival （ P 〉 0.05 ）. Multivariate analysis showed that serosal infiltration and LNR 〉 0, 2 were independent factors of the progno- sis in nodes - positive patients. Conclusion Lymph nodes metastasis is closely related to the prognosis of the pancreatic cancer. The number of lymph nodes examined has significant effect on the prognosis of the nodes - negative pancreatic cancer. LNR 〉 0.2 is independent predictor of the prognosis in the nodes - positive patients.