胰腺癌患者胰腺切除术后腹主动脉旁淋巴结状态与其预后及临床病理特征的关系

马继春; 姚继彬; 杨健; 刘飘; 张永斌; 葛龙; 达明绪

doi:10.3971/j.issn.1000-8578.2017.17.0349

胰腺癌患者胰腺切除术后腹主动脉旁淋巴结状态与其预后及临床病理特征的关系

Relationship of Para-aortic Lymph Nodes (PALN) Status with Prognosis and Clinicopathological Features of Pancreatic Cancer Patients After Pancreatectomy

摘要

摘要:
目的探讨胰腺癌患者胰腺切除术后16组淋巴结状态与其预后及临床病理特征的关系。
方法检索PubMed数据库、Cochrane Library、Embase数据库、CNKI数据库、万方数据库及中国生物医学文献（CBM）数据库，均从建库开始截至2016年7月，查找胰腺癌患者行胰腺切除术后腹主动脉旁淋巴结（para-aortic lymph noldes，PALN）病理检查结果与患者临床病理特征及生存率相关文献，采用Stata 12.0软件进行Meta分析。
结果共纳入14项研究，其中回顾性研究12项，前瞻性研究2项，涉及胰腺癌患者3 279人。Meta分析结果显示，PALN阳性患者1年生存率（OR=0.55，95%CI：0.41~0.73，P=0.001）和2年生存率（OR=0.46，95%CI：0.33~0.63，P=0.001）均明显低于PALN阴性患者，同时提示PALN阳性可能会增加切缘阳性的风险（OR=2.45，95%CI：1.79~3.36，P=0.001）。在其他组淋巴结转移方面，PALN病理检查阳性会增加12组（OR=3.34，95%CI：2.13~5.23，P=0.001）、14组（OR=2.76，95%CI：1.90~4.01，P=0.001）、17组（OR=2.41，95%CI：1.63~3.57，P=0.001）淋巴结转移的风险。在T分期方面，胰腺癌PALN阳性患者T1/T2期所占比例低于PALN阴性患者（OR=0.31，95%CI：0.10~0.98，P=0.046）。
结论胰腺癌患者行胰腺切除术后，腹主动脉旁淋巴结阳性患者近期生存率低，手术切缘阳性的风险较高，远处转移的可能较大。PALN状态与胰腺癌患者预后及临床病理特征相关。

Abstract:
Objective To explore the relationship of para-aortic lymph nodes (PALN) status with prognosis and clinicopathological features of pancreatic carcinoma patients after pancreatectomy.
Methods PubMed, Cochrane Library, Embase, CNKI, Wanfang Database and CBM were searched to identify the studies reporting the relationship of PALN with clinicopathological features and short-term survival of pancreatic cancer patients after pancreatectomy from inception to July 2016. Meta-analysis was performed by Stata 12.0 software.
Results A total of 14 studies were included, involving 3279 pancreatic cancer patients. Patients with positive PALN had worse one-year (OR=0.55, 95%CI:0.41-0.73, P=0.001) and two-year (OR=0.46, 95%CI:0.33-0.63, P=0.001) survival than those with negative PALN. Positive PALN was associated with increased possibility of R1 resection(OR=2.45, 95%CI:1.79-3.36, P=0.001), station 12 (OR=3.34, 95%CI:2.13-5.23, P=0.001), station 14(OR=2.76, 95%CI:1.90-4.01, P=0.001) and station 17 (OR=2.41, 95%CI:1.63-3.57, P=0.001) malignant infiltration, and decreased T1/T2 stage percentage(OR=0.31, 95%CI:0.10-0.98, P=0.046).
Conclusion The pancreatic cancer patients with positive PALN may suffer from a low short-term survival, high possibility of positive margin resection and malignant infiltration. PALN status is associated with clinicopathological features and prognosis of pancreatic cancer patients.

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