Clinico-Pathological Characteristics And Influecing Factors Of Lymph Node Metastasis Of Pancreatic Carcinoma In Head

Objectives:To investigate the clinico-pathological characteristics and influencing factors of the lymph node metastasis of pancreatic carcinoma in head; and the significance of VEGF-C and VEGFR-3 protein expression in lymphatic metastasis of pancreatic cancer.Methods:The clinico-pathological characteristics and the influencing factors of lymph node metastasis of 132 patients with pancreatic carcinoma in head were analyzed retrospectively. The lymph nodes of the species of pancreaticoduodenectomy for pancreatic carcinoma in head were dissected by method of operative microscope. The chi- square test was conducted to analyze the relationship between lymph node metastasis and the cilinco-pathological factors.The expression of VEGF-C and VEGFR-3 protein in pancreatic carcinoma in head and lymph nodes was assayed by the means of immunohistochemical method in 25 patients who have undergone the surgical procedure of pancreaticoduodenectomy. The significance of VEGF-C and VEGFR-3 protein expression in lymphatic metastasis of pancreatic cancer was also analyzed.Results:A total of 132 cases with pancreatic carcinoma in head underwent the surgical procedure of pancreaticoduodenectomy. The incidence rate of lymph node metastasis was 59.85%(79/132) in cases of pancreatic carcinoma in head. The most common involved lymph node stations were No.13,No.14,No.16,No.12 and No.8 groups. The involved No.16 group lymph nodes in para-aortic region almost located within the triangular region surrounded by the abdominal aorta, inferior vena cava and left renal vein. Ten pancreatic cancer derived from the uncinate process only had superior mesenteric vessel lymph nodes metastasis without involvement of postpancreatoduodenal lymph nodes. Lymph node metastasis of pancreatic carcinoma in head was associated with tumor differentiation, tumor stage(T), and tumor neural invasion by the statistic analysis of chi-square test (p<0.05).The positive rates of VEGF-C,VEGFR-3 were 80%(20/25),92%(23/25) respectively in pancreatic cancer. The expression of VEGF-C,VEGFR-3 in the edge of the tumor was significantly higher than that in the center of the tumor; and the expression of VEGF-C,VEGFR-3 were significantly higher in the metastasized lymph nodes than that in the non-metastasized ones tested by HE method. There was obvious correlation between the expression of VEGF-C,VEGFR-3 and the cancer invasion of the duodenum and the differentiation of the tumor, especially the differentiation of the tumor.Conclusion:The lymph node metastasis of pancreatic carcinoma in head occurs in a vast range and usually has a high incidence rate, especially in the lymph nodes of No.13,No.14,No.16,No.12 and No.8 groups. It was inferred that regional extended lymphadenectomy may improve the effectiveness of surgical treatment for pancreatic carcinoma in head. The expression of VEGF-C and VEGFR-3 protein is closely related to the incidence of lymph node metastasis of the pancreatic carcinoma in head. It was demonstrated that the VEGF-C and VEGFR-3 maybe induce lymphangiogenisis in pancreatic cancer, and thus promote the tumor cell lymph metastasis.