区域淋巴结大小对胰头腺癌术后复发的影响

Effect of regional lymph node diameter on postoperative recurrence in pancreatic cancer patients

目的探讨区域淋巴结平均直径大小对无淋巴结转移胰头腺癌术后肿瘤复发的影响。方法回顾性分析联勤保障部队第九〇九医院2017年1月至2019年6月收治的49例胰头腺癌患者临床资料。采用受试者操作特征(ROC)曲线分析区域淋巴结平均直径预测肿瘤复发最佳界值,分析入组患者区域淋巴结平均直径及是否复发与临床病理特征的关系,采用logistic回归分析术后3年肿瘤复发的影响因素。结果49例胰头腺癌患者根据是否复发分为复发组(n=29)和无复发组(n=20),复发率为59.18%。ROC曲线分析发现,淋巴结平均直径预测肿瘤复发的最佳界值为0.635 cm,曲线下面积为0.82,敏感性为0.69,特异性为0.85。淋巴结平均直径增大与肿瘤直径≥2 cm(t=-2.12,P=0.040)、肿瘤中低分化(t=-2.24,P=0.013)、脉管侵犯(t=-3.47,P=0.001)、神经侵犯(t=-3.75,P<0.001)、被膜侵犯(t=-4.25,P<0.001)、肿瘤复发(t=-4.42,P<0.001)有关。单因素分析显示,肿瘤直径(χ^(2)=5.98,P=0.015)、肿瘤分期(χ^(2)=3.88,P=0.049)、肿瘤分化(χ^(2)=5.98,P=0.015)、脉管侵犯(χ^(2)=3.84,P=0.050)、被膜侵犯(χ^(2)=5.79,P=0.016)、淋巴结平均直径(χ^(2)=15.61,P<0.001)、术后化疗(χ^(2)=3.89,P=0.049)均与胰头腺癌患者术后3年肿瘤是否复发有关。多因素分析显示,肿瘤直径≥2 cm(OR=2.72,95%CI为1.46~11.28,P=0.016)、肿瘤中低分化(OR=2.22,95%CI为1.23~6.53,P=0.020)、被膜侵犯(OR=2.30,95%CI为2.19~8.91,P=0.017)、淋巴结平均直径≥0.635 cm(OR=7.93,95%CI为1.25~50.31,P=0.002)均是胰头腺癌患者术后3年肿瘤复发的独立危险因素。结论无淋巴结转移的胰头腺癌患者中,肿瘤直径≥2 cm、肿瘤中低分化、被膜侵犯和淋巴结平均直径≥0.635 cm是肿瘤术后复发的独立危险因素;区域淋巴结平均直径≥0.635 cm的患者术后肿瘤复发可能性增大,可以作为术后评估依据,具有一定的临床应用价值。

Objective To investigate the effect of the average diameter of regional lymph node on tumor recurrence after operation of pancreatic head adenocarcinoma without lymph node metastasis.Methods Clinical data of 49 patients with pancreatic head adenocarcinoma admitted to the 909th Hospital of Joint Logistic Support Force from January 2017 to June 2019 were retrospectively analyzed.The receiver operating characteristic(ROC)curve was used to analyze the average regional lymph node diameter for predicting the optimal threshold of tumor recurrence.The relationship between the average diameter of regional lymph nodes,recurrence and clinicopathological features were analyzed.The influencing factors of tumor recurrence 3 years after surgery were analyzed by logistic regression.Results All 49 patients with pancreatic head adenocarcinoma were divided into a relapse group(n=29)and a no-recurrence group(n=20)based on whether the tumor recurred or not,and the recurrence rate was 59.18%.ROC curve analysis showed that the best threshold of average regional lymph node diameter for predicting tumor recurrence was 0.635 cm,the area under the curve was 0.82,the sensitivity was 0.69,and the specificity was 0.85.The average diameter of regional lymph nodes increased in patients with tumor diameter≥2 cm(t=-2.12,P=0.040),tumor with moderate and poorly differentiation(t=-2.24,P=0.013),vascular invasion(t=-3.47,P=0.001),nerve invasion(t=-3.75,P<0.001),capsular invasion(t=-4.25,P<0.001),and tumor recurrence(t=-4.42,P<0.001).Univariate analysis showed that tumor diameter(χ^(2)=5.98,P=0.015),tumor stage(χ^(2)=3.88,P=0.049),tumor differentiation(χ^(2)=5.98,P=0.015),vascular invasion(χ^(2)=3.84,P=0.050),capsular invasion(χ^(2)=5.79,P=0.016),average lymph node diameter(χ^(2)=15.61,P<0.001),and postoperative chemotherapy(χ^(2)=3.89,P=0.049)were all related to whether the tumor recurred or not in patients with pancreatic head adenocarcinoma 3 years after surgery.Multivariate analysis results showed that tumor diameter≥2 cm(OR=2.72,95%CI:1.46-11.28,P=0.016),tumor with moderate and poorly differentiation(OR=2.22,95%CI:1.23-6.53,P=0.020),capsular invasion(OR=2.30,95%CI:2.19-8.91,P=0.017),and average lymph node diameter≥0.635 cm(OR=7.93,95%CI:1.25-50.31,P=0.002)were all independent influencing factors for tumor recurrence in pancreatic head adenocarcinoma patients 3 years after surgery.Conclusion In patients with pancreatic head adenocarcinoma without lymph node metastasis,tumor diameter≥2 cm,tumor with moderate and poorly differentiation,capsular invasion and average lymph node diameter≥0.635 cm are independent risk factors for postoperative tumor recurrence.Patients with the average diameter of regional lymph nodes≥0.635 cm increase the possibility of tumor recurrence after surgery,which can be used as the basis for postoperative evaluation and has certain clinical application value.