在切除的无淋巴节点的胰腺或乳头部腺癌中，常规和详细的淋巴结分析存在不一致，与不良生存结局相关：一项单一机构的分析。
Discordance Between Conventional and Detailed Lymph Node Analysis in Resected, Node-negative Pancreatic or Ampullary Adenocarcinomas and Association with Adverse Survival Outcomes: A Single-institution Analysis.
发表日期：2023 Apr 13
作者：
Mohamedraed Elshami, Alwalid K Ammoun, Wadad S Mneimneh, Henry J Stitzel, Jonathan J Hue, Victoria S Wu, Ravi K Kyasaram, John Shanahan, Tashinga Musonza, John B Ammori, Jeffrey M Hardacre, Jordan M Winter, Mohamed ElHag, Lee M Ocuin
来源：
ANNALS OF SURGERY
摘要：
为评估在淋巴结（LN）的详细病理检查中发现的、以往被传统分析认为是阴性的、在手术切除胰腺腺癌（PDAC）或乳头部腺癌（AA）患者中隐匿性转移（OM）的频率，并研究OM与总生存期（OS）的关联。没有 LN 转移的病理学证据导致患者预后不佳可能是由于未被传统 LN 分析发现的OM。从我们的机构数据库中确定2010-2020年间LN阴性的PDAC或AA手术切除患者。重新分析了原始苏木精与伊红（H&E）片。此外，选择性的 LN 被 H&E（每个 LN 3 部分）和泛细胞角蛋白（AE1-AE3/PCK26）免疫组织化学分析。重新检查了74名LN阴性患者的598个 LN。19名患者（25.7%）有OM；9名患者（47.4%）在免疫组织化学分析中发现，但在 H&E 中没有。阳性的 LN 数量在1-3个之间。没有任何临床特征、病理特征或治疗相关因素与OM相关。在常规 LN 分析中，19名患者中有3名（15.8%）为IA期，9名（26.5%）为IB期，7名（36.8%）为IIA期。在详细 LN 分析中，11名患者（57.9%）被升级到IIB期，而8名（42.1%）仅有孤立的肿瘤细胞（N0i+）。OM与较短的OS相关（中位 OS：22.3 vs. 50.5 个月；HR=3.95，95% CI：1.58-9.86）。在手术切除的 PDAC 和 AA 中，常规和详细的 LN 病理学分析之间存在着26%的不一致率。OM的存在与较短的OS相关。版权所有©2023 Wolters Kluwer Health，Inc.保留所有权利。
To assess the frequency of occult metastases (OM) in patients with resected pancreatic adenocarcinoma (PDAC) or ampullary adenocarcinoma (AA) discovered on detailed pathologic examination on lymph nodes (LN) previously considered negative by conventional analysis, and to examine the association between OM and overall survival (OS).Poor prognosis of patients with no pathologic evidence of LN metastases may be due to OM that are not detected on conventional LN analysis.Patients with LN-negative resected PDAC or AA (2010-2020) were identified from our institutional database. Original hematoxylin & eosin (H&E) slides were re-analyzed. In addition, selected LN were analyzed by H&E (3 sections/LN) and pan-cytokeratin (AE1-AE3/PCK26) immunohistochemistry.A total of 598 LNs from 74 LN-negative patients were re-examined. Nineteen patients (25.7%) had OM; 9 (47.4%) were found with immunohistochemistry but not on H&E. The number of positive LNs ranged from 1-3. No clinicodemographic, pathologic, or treatment-related factors were associated with OM. On conventional LN analysis, 3/19 patients (15.8%) had stage IA, 9/19 (26.5%) had stage IB, and 7/19 (36.8%) had stage IIA. On detailed LN analysis, 11/19 patients (57.9%) were upstaged to IIB, while 8/19 (42.1%) had isolated tumor cells only (N0i+). OM was associated with shorter OS (median OS: 22.3 vs. 50.5 mo; HR=3.95, 95% CI: 1.58-9.86).There is a 26% discordance rate between conventional and detailed LN pathologic analysis in resected PDAC and AA. The presence of OM is associated with shorter OS.Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.