胰腺癌淋巴结转移情况对预后的影响

The influence of lymph node metastasis on prognosis of pancreatic carcinoma

目的研究淋巴结转移情况对胰腺癌患者预后的影响。方法回顾性分析我院2009年1月至2015年8月72例行根治性手术的胰腺癌患者淋巴结转移情况及其对预后的影响。结果检出淋巴结961枚,平均13.3枚/例;其中阳性淋巴结87枚。单因素分析显示:得到随访的有淋巴结转移者(PN1)33例(47%),中位生存期为8.6个月;得到随访的无淋巴结转移者(PN0)37例(53%),中位生存期18.6个月;无淋巴结转移者生存率显著高于有淋巴结转移患者(P<0.05)。在有淋巴结转移的患者中,淋巴结阳性比率(LNR)>0.2者14例(42%),中位生存期为6.4个月;LNR≤0.2者19例(58%),中位生存期11.4个月;LNR>0.2者生存率显著低于LNR≤0.2者(P<0.05)。淋巴结转移局限于第1站的有17例(52%),中位生存期为11.0个月;第2站以上淋巴结转移者16例(48%),中位生存期7.5个月;第2站以上淋巴结转移者生存率显著低于淋巴结转移局限于第1站者(P<0.05)。多因素分析显示:第2站以上淋巴结转移、淋巴结阳性比率>0.2仍然是影响胰腺癌预后的独立危险因素(P<0.05)。此外,肿瘤侵犯范围、综合治疗、肿瘤分化程度也影响胰腺癌预后(P<0.05)。结论胰腺癌淋巴结转移率较高,LNR>0.2及第2站以上淋巴结转移是影响胰腺癌预后的独立危险因素。

Objective To explore the impact of lymph nodes metastasis on prognosis of pancreatic carcinoma patients. Methods The clinical data of lymph nodes metastasis and clinic outcome of 72 patients with pancreatic caicinoma who underwent radial surgery from Jan. 2009 to Aug. 2015 in our hospital were analyzed retrospectively.Results A total of 961 lymph nodes were detected, 13.3 nodes in one case on average. Among them, 87 lymph nodes were positive, 2.6 nodes in one case on average. Univariate analysis showed that 33 cases who had followup visit were lymph nodes metastasis (PN1, 47.%), in which the median survival was 8.6 mon; 37 cases who had follow-up visit were non-lymph nodes metastasis (PN0, 53.%), in which the median survival was 18.6 mon, and the survival rate with non-lymph nodes metastasis was higher than those with lymph nodes metastasis (P<0.05).Among lymph nodes metastasis patients, lymph nodes positive rate with LNR >0.2 was 14 cases (42%), in which the median survival was 6.4 mon; lymph nodes positive rate with LNR≤0.2 was 19 cases (58%), in which the median survival was 11.4 mon; and the survival rate with LNR>0.2 was significant lower than that with LNR≤0.2 (P<0.05). Lymph nodes metastasis which was limited in the first period were 17 cases (52%), the median survival metastasis was 11.0 mon; the lymph nodes metastasis beyond the first period were 16 cases (48%), the median survival metastasis was 7.5 mon; and the survival rate beyond the first period was significant lower than that within the first period (P<0.05). Multivariate analysis showed that lymph nodes metastasis beyond the first period, lymph nodes positive rate with LNR>0.2 were independent risk factors affecting the prognosis in pancreatic cancer patients (P<0.05). Besides, tumor invasion range, composite curing, the degree of tumor differentiation all affected the prognosis. Conclusion The rate of lymph nodes metastasis is high. Lymph nodes metastasis beyond the first period and LNR>0.2 are independent risk factors affecting the prognosis in pancreatic cancer patients.