医学
胰腺导管腺癌
阶段(地层学)
淋巴
淋巴结
肿瘤科
胰腺癌
内科学
腺癌
胃肠病学
癌症
外科
病理
生物
古生物学
作者
Giuseppe Malleo,Laura Maggino,Motaz Qadan,Giovanni Marchegiani,Cristina R. Ferrone,Salvatore Paiella,Claudio Luchini,Mari Mino‐Kenudson,Paola Capelli,Aldo Scarpa,Keith D. Lillemoe,Claudio Bassi,Carlos Fernández‐del Castillo
出处
期刊:Annals of Surgery
[Ovid Technologies (Wolters Kluwer)]
日期:2020-11-09
卷期号:276 (5): e518-e526
被引量:9
标识
DOI:10.1097/sla.0000000000004552
摘要
Objective: The aim of this study was to reappraise the optimal number of examined lymph nodes (ELNs) in pancreatoduodenectomy (PD) for pancreatic ductal adenocarcinoma (PDAC). Summary background data: The well-established threshold of 15 ELNs in PD for PDAC is optimized for detecting 1 positive node (PLN) per the previous 7th edition of the American Joint Committee on Cancer (AJCC) staging manual. In the framework of the 8th edition, where at least 4 PLN are needed for an N2 diagnosis, this threshold may be inadequate for accurate staging. Methods: Patients who underwent upfront PD at 2 academic institutions between 2000 and 2016 were analyzed. The optimal ELN threshold was defined as the cut-point associated with a 95% probability of identifying at least 4 PLNs in N2 patients. The results were validated addressing the N-status distribution and stage migration. Results: Overall, 1218 patients were included. The median number of ELN was 26 (IQR 17–37). ELN was independently associated with N2-status (OR 1.27, P < 0.001). The estimated optimal threshold of ELN was 28. This cut-point enabled improved detection of N2 patients and stage III disease (58% vs 37%, P = 0.001). The median survival was 28.6 months. There was an improved survival in N0/N1 patients when ELN exceeded 28, suggesting a stage migration effect (47 vs 29 months, adjusted HR 0.649, P < 0.001). In N2 patients, this threshold was not associated with survival on multivariable analysis. Conclusion: Examining at least 28 LN in PD for PDAC ensures optimal staging through improved detection of N2/stage III disease. This may have relevant implications for benchmarking processes and quality implementation.
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