Occurrence pattern and impact of lymph node micrometastasis in pancreatic head cancer / 中华肿瘤杂志

ABSTRACT

Objective@#To investigate the occurrence of lymph node micrometastasis in pancreatic head carcinoma and analyze its effect on the prognosis of patients.@*Methods@#The lymph nodes in 40 patients who received pancreatoduodenectomy with regional lymphadenectomy were dissected by surgical magnification microscopy. The expression of cytokeration(AE1/E3) were detected by immunohistochemical staining in the pathologically negative lymph nodes. The frequency of lymph nodes metastases and micrometastases, as well as the relationship between metastasis and prognosis were analyzed.@*Results@#1 550 lymph nodes were dissected from 40 patients. Lymph node metastases was pathologically detected in 27 patients (67.5%) and in 199 lymph nodes(12.8%). No.13(24.1%, 68/282), No.14(18.1%, 58/321), No.12(12.7%, 31/245), No.16(12.3%, 30/243) and No.17(11.4%, 12/105) lymph nodes groups had higher frequency of metastases. Lymph node micrometastases was immunohistochemically detected in 6 patients and 130 lymph nodes. No.14(16.5%, 53/321), No.13(15.2%, 43/282), No.16(6.2%, 15/243), No.12(4.9%, 12/245) and No.8(5.0%, 7/141) lymph nodes groups had higher frequency of micrometastases. The total ratio of patients with postive lymph nodes invasion and the ratio of positive lymph nodes invasion were 82.5% and 21.2%. 11 patients survived more than one year. 29 patients died of recurrence or metastasis within 8~11 months after surgery. The 1-year survival rate was 27.5%. 1-year survival rate was 14.9% in HE (+ ) patients, and 33.3% in HE (-) AE1/E3 (+ ) patients (P=0.632). AE1/E3 (-) HE (-) patients had a 1-years survival rate of 71.4%, which was statistically higher than that in HE (+ ) group patients (P=0.010).@*Conclusions@#AE1/E3 combined with pathological examination can significantly improve the detection rate of lymph nodes micrometastasis in pancreatic head carcinoma patients. Micrometastasis is commonly found in No 13, 14, 12, 16, 8 lymph nodes groups. Lymph nodes micrometastasis had a significant effect on the prognosis of patients. Special attention should be payed to No 13, 14, 16, 12, 17 lymph nodes groups during radical duodenopancreatectomy.