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

Abstract

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

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.

Figures/Tables4

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

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

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

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