【摘要】：背景本項研究比較胰頭惡性腫瘤行胰十二指腸切除術(shù)后的臨床及病理學(xué)各項因素情況,分析淋巴結(jié)轉(zhuǎn)移數(shù)目及LNR(lymph node ratio)對患者術(shù)后生存時間的影響。通過兩種不同的方法初步探索估計MNELN(Minimal Number of Examined Lymph Nodes)最小淋巴結(jié)檢測數(shù)來保證胰腺惡性腫瘤的腫瘤狀態(tài)可以得到準確的判斷。材料與方法研究151例因胰頭惡性腫瘤行胰十二指腸切除術(shù)后的患者,應(yīng)用單因素及多因素分析的方法分析比較其臨床病理學(xué)因素對預(yù)后的影響,包括淋巴結(jié)轉(zhuǎn)移數(shù)目及LNR。根據(jù)每增長一個淋巴結(jié)檢測數(shù)NELN,p N1患者在病人中的比例變化,來推測可能的MNELN最小淋巴結(jié)檢測數(shù)。應(yīng)用建立的二項式概率模型推算需要檢測出一枚淋巴結(jié)陽性所需要的MNELN。結(jié)果患者一年總生存率70%,兩年總生存率49%。平均淋巴結(jié)檢測數(shù)目為7.4枚,平均陽性淋巴結(jié)數(shù)目為0.9枚。在單因素分析中發(fā)現(xiàn)有無淋巴結(jié)轉(zhuǎn)移,LNR≥0.1,TNM分期p T情況,TNM腫瘤分期均影響術(shù)后五年生存率(P0.05)。在多因素分析中,有無淋巴結(jié)轉(zhuǎn)移,與LNR≥0.1都獨立地與較長的生存時間有關(guān)。生存曲線分析中,LNR≥0.1(P=0.03),LNR≥0.2(P=0.016),顯著影響了患者的生存時間。隨著淋巴結(jié)檢測數(shù)NELN的增長,pN1病人比例的產(chǎn)生變化,pN1的比例在NELN達到11這個數(shù)字時有一次顯著地提示,p N1比例進入了一個平臺期,無明顯升高趨勢。應(yīng)用二項概率法則得到本樣本至少需要檢測24枚淋巴結(jié)才能檢測出一枚陽性淋巴結(jié)。結(jié)論LNR相較于淋巴結(jié)轉(zhuǎn)移數(shù)目對胰頭惡性腫瘤行胰十二指腸切除術(shù)后預(yù)后預(yù)測更有意義。MNELN需要更大樣本量的研究才能的到更為令人信服的結(jié)果。
[Abstract]:Background to compare the clinical and pathological factors after pancreaticoduodenectomy for pancreatic head malignant tumors, and to analyze the effect of lymph node metastasis and LNR (lymph node ratio) on postoperative survival time. Two different methods were used to estimate the minimum number of lymph nodes detected by MNELN (Minimal Number of Examined Lymph Nodes) in order to ensure that the tumor status of pancreatic malignant tumors could be judged accurately. Materials and methods A total of 151 patients with malignant tumors of pancreatic head underwent pancreaticoduodenectomy. Univariate and multivariate analysis were used to compare the effect of clinicopathological factors on prognosis, including lymph node metastasis and LNR.. The possible minimum number of NELN,p N1 lymph nodes was estimated based on the percentage of patients with NELN,p N1 per increased lymph node count. Using the established binomial probability model to calculate the MNELN. needed to detect a positive lymph node Results the overall one-year survival rate was 70%, and the 2-year overall survival rate was 49%. The average number of lymph nodes detected was 7.4 and the average number of positive lymph nodes was 0.9. In univariate analysis, lymph node metastasis, LNR 鈮，

本文編號：2331205