目的 探讨淋巴结转移对胰头导管腺癌胰十二指肠切除术后预后的影响.方法 提取美国SEER数据库2004年1月至2013年12月共6549例诊断为胰头导管腺癌且行胰十二指肠切除术的患者临床病理数据,回顾性分析淋巴结转移情况与预后的关系.结果 共有6549例患者入选,患者1、3、5年癌症相关生存率分别为73%、29%、19%,中位生存时间为21个月.单因素分析显示,患者性别、年龄、分化程度、肿瘤直径、侵袭范围、是否淋巴结转移、淋巴结转移数、淋巴结检出数、淋巴结阳性率(P<0.05)与预后相关,人种、婚姻状态与预后无统计学相关性(P>0.05).多因素Cox回归分析显示,患者性别、年龄、分化程度、肿瘤直径、侵袭范围、淋巴结检出数、淋巴结阳性率与预后相关(P<0.05).无淋巴结转移的患者5年癌症相关生存率31%,中位生存期为29.7个月;淋巴结转移的患者5年癌症相关生存率14%,中位生存期为19.1个月,差异有统计学意义(P<0.05).淋巴结检出数<15个时患者5年癌症相关生存率17%,中位生存期为20.3个月,淋巴结转移率为62.9%;淋巴结检出数≥15个时患者5年癌症相关生存率20%,中位生存期为22.0个月,淋巴结转移率为78.0%,差异有统计学意义(P<0.05).进行分层分析时,无论是否有淋巴结转移,淋巴结检出数增加可显著改善预后(P<0.05).5年癌症相关生存率随着淋巴结阳性率升高而降低(P<0.05).结论 胰头导管腺癌患者淋巴结转移情况与预后密切相关,淋巴结检出数、淋巴结阳性率是其预后的独立影响因素.%Objective To explore the impact of lymph node metastasis on the prognosis of patients with pancreatic head duct adenocarcinoma after pancreatoduodenectomy. Methods The clinical and pathological data of 6 549 patients who diagnosed with pancreatic head ductal adenocarcinoma, and then undergone pancreatoduodenectomy, were extracted from Jan. 2004 to Dec. 2013 by American SEER database. The relationship between lymph node metastasis and prognosis was analyzed retrospectively. Results A total of 6549 patients were selected. The 1, 3, and 5- year cancer specific survival rates were 73%, 29% and 19%, and the median survival time was 21 months. Univariate analysis showed that gender, age, degree of differentiation, tumor size, invasion range, whether lymph node metastasis (LNM) present or not, number of lymph node metastasis (nLNM), lymph node examined (LNE), lymph node positive rate (LNR) (P<0.05) were correlated with the prognosis, regardless of race, marital status (P>0.05). Multivariate Cox regression analysis showed that gender, age, differentiation, tumor size, invasive range, whether LNM present or not, LNE, LNR were correlated with prognosis (P<0.05). The 5- year cancer specific survival rate of patients without lymph node metastasis was 31%, the median survival time was 29.7 months; and the 5- year cancer specific survival rate of lymph node metastasis patients was 14%, the median survival time was 19.1 months, the difference was statistically significant (P<0.05).If LNE < 15, the 5-year cancer specific survival was 17%, the median survival time was 20.3 months, and the lymph node metastasis rate was 62.9%; if LNE ≥15, the 5-year cancer specific survival was 20%, the median survival time was 22.0 months, and the lymph node metastasis rate was 78.0%; the difference was statistically significant (P<0.05). In the stratified analysis, no matter whether lymph node metastasis or not, the increase in the number of LNE improved prognosis significantly (P<0.05). The 5- year cancer specific survival rate decreased with the increase of LNR (P<0.05). Conclusion For patients with pancreatic head ductal carcinoma, LNM was closely correlated with prognosis. In addition, factors including LNE, LNR were independent prognosis factors for patients with pancreatic head ductal carcinoma.
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