区域淋巴结大小对胰头腺癌术后复发的影响

摘要/Abstract

摘要：

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（χ²=5.98，P=0.015）、肿瘤分期（χ²=3.88，P=0.049）、肿瘤分化（χ²=5.98，P=0.015）、脉管侵犯（χ²=3.84，P=0.050）、被膜侵犯（χ²=5.79，P=0.016）、淋巴结平均直径（χ²=15.61，P<0.001）、术后化疗（χ²=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。

关键词:胰腺肿瘤,胰十二指肠切除术,预后

Abstract:

ObjectiveTo investigate the effect of the average diameter of regional lymph node on tumor recurrence after operation of pancreatic head adenocarcinoma without lymph node metastasis.MethodsClinical 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.ResultsAll 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 （χ²=5.98，P=0.015）， tumor stage （χ²=3.88，P=0.049）， tumor differentiation （χ²=5.98，P=0.015）， vascular invasion（χ²=3.84，P=0.050）， capsular invasion （χ²=5.79，P=0.016）， average lymph node diameter （χ²=15.61，P<0.001）， and postoperative chemotherapy （χ²=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.ConclusionIn 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.

Key words:Pancreatic neoplasms,Pancreaticoduodenectomy,Prognosis

魁国菊, 黄江宾, 张文华, 杨立民. 区域淋巴结大小对胰头腺癌术后复发的影响[J]. 国际肿瘤学杂志, 2023, 50(10): 608-613.

Kui Guoju, Huang Jiangbin, Zhang Wenhua, Yang Limin. Effect of regional lymph node diameter on postoperative recurrence in pancreatic cancer patients[J]. Journal of International Oncology, 2023, 50(10): 608-613.

图/表4

图1

表1

49例胰头腺癌患者淋巴结平均直径与临床病理特征的关系 $(\overline{x}_{\pm s})$"

项目	例数	淋巴结平均直径（cm）	t值	P值
年龄（岁）
<50	15	0.62±0.11	0.36	0.719
≥50	34	0.61±0.09	0.36	0.719
性别
女	21	0.64±0.09	1.47	0.150
男	28	0.59±0.10	1.47	0.150
BMI（kg/m²）
<24	42	0.63±0.12	0.84	0.427
≥24	7	0.60±0.08	0.84	0.427
糖尿病史
无	35	0.62±0.10	0.56	0.579
有	14	0.60±0.10	0.56	0.579
吸烟史
无	37	0.62±0.10	0.01	0.921
有	12	0.61±0.10	0.01	0.921
肿瘤直径（cm）
<2	24	0.58±0.11	-2.12	0.040
≥2	25	0.64±0.08	-2.12	0.040
肿瘤分期
Ⅰ	34	0.59±0.10	-1.69	0.097
Ⅱ	15	0.65±0.08	-1.69	0.097
肿瘤分化
高分化	24	0.59±0.09	-2.24	0.013
中低分化	25	0.65±0.10	-2.24	0.013
脉管侵犯
无	37	0.58±0.09	-3.47	0.001
有	12	0.69±0.07	-3.47	0.001
神经侵犯
无	38	0.56±0.10	-3.75	<0.001
有	11	0.67±0.10	-3.75	<0.001
被膜侵犯
无	32	0.56±0.10	-4.25	<0.001
有	17	0.67±0.08	-4.25	<0.001
淋巴结个数（个）
<17	22	0.63±0.06	0.86	0.413
≥17	27	0.60±0.07	0.86	0.413
肿瘤复发
无	20	0.54±0.08	-4.42	<0.001
有	29	0.66±0.08	-4.42	<0.001

表1

表2

49例胰头腺癌患者术后3年肿瘤是否复发单因素分析（例）"

因素	无复发组（n=20）	复发组（n=29）	χ²值	P值	因素	无复发组（n=20）	复发组（n=29）	χ²值	P值
年龄（岁）						肿瘤分化
<50	5	10	0.50	0.479	高分化	14	10	5.98	0.015
≥50	15	19	0.50	0.479	中低分化	6	19
性别					脉管侵犯
女	8	13	0.11	0.737	无	18	19	3.84	0.050
男	12	16	0.11	0.737	有	2	10
BMI（kg/m²）					神经侵犯
<24	17	25	<0.01	>0.999	无	17	21	0.48	0.491
≥24	3	4	<0.01	>0.999	有	3	8
糖尿病史					被膜侵犯
无	14	21	0.03	0.854	无	17	15	5.79	0.016
有	6	8	0.03	0.854	有	3	14
吸烟史					淋巴结个数（个）
无	15	22	<0.01	>0.999	<17	11	11	1.39	0.238
有	5	7	<0.01	>0.999	≥17	9	18
肿瘤直径（cm）					淋巴结平均直径（cm）
<2	14	10	5.98	0.015	<0.635	17	8	15.61	<0.001
≥2	6	19	5.98	0.015	≥0.635	3	21
肿瘤分期					术后化疗
Ⅰ	17	17	3.88	0.049	是	17	17	3.89	0.049
Ⅱ	3	12	3.88	0.049	否	3	12

表2

因素	β值	SE值	Waldχ²值	OR值	95%CI	P值
肿瘤直径（<2 cm为对照）	1.821	0.818	1.684	2.72	1.46~11.28	0.016
肿瘤分期（Ⅰ期为对照）	0.096	1.001	0.039	1.10	0.16~7.83	0.623
肿瘤分化（高分化为对照）	1.195	0.857	1.552	2.22	1.23~6.53	0.020
被膜侵犯（无为对照）	1.262	0.891	1.373	2.30	2.19~8.91	0.017
淋巴结平均直径（<0.635 cm为对照）	2.070	0.943	4.821	7.93	1.25~50.31	0.002
术后化疗（否为对照）	0.537	0.947	0.322	0.58	0.09~3.74	0.570

表3

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