Evaluation of extra capsular lymph node involvement in patients with extra-hepatic bile duct cancer

Abstract

BackgroundLymph node metastasis is one of the most important prognostic factors for extra-hepatic bile duct carcinoma (ExHBDC). Extra capsular lymph node involvement (ExCLNI) is the extension of cancer cells through the nodal capsule into the perinodal fatty tissue. The prognostic impact of ExCLNI has been shown to be significant mainly in head and neck malignancies. Recently, the prognostic impacts of ExCLNI have evaluated in gastrointestinal malignancies. However no data is available regarding the incidence and prognostic significance of extra-capsular lymph node involvement (ExCLNI) in resectable ExHBDCs. The aim of the present study is first to evaluate the incidence of ExCLNI in surgically-treated ExHBDCs and second, to determine the prognostic impact of ExCLNI in patients with surgically-treated ExHBDCs.MethodsA total of 228 patients (110 cases of hilar cholangiocarcinoma and 118 cases of distal cholangiocarcinoma) with surgically-treated ExHBDCs were included in this retrospective study. ExCLNI was defined as the extension of cancer cells through the nodal capsule into the perinodal fatty tissue. The existence of ExCLNI and its prognostic value were analyzed as a subgroup of lymph node metastasis.ResultsExCLNI was detected in only 22% of patients with lymph node metastasis of surgically-treated ExHBDC. The presence of ExCLNI correlated with distal cholangiocarcinoma (p = 0.002). On univariate analysis for survival, perineural invasion, vascular invasion, histological grade, and lymph node metastasis were statistically significant factors. On multivariate analysis, only lymph node metastasis was identified as a significant independent prognostic factor in patients with resectable ExHBDC. Subgroups of lymph node metastasis including the presence of ExCLNI, location of lymph node metastasis, and the number of lymph node metastasis had no statistically significant impact on survival.ConclusionExCLNI was present in only 22% of the LNM (7% of overall patients) in patients with surgical treated ExHBDCs. And ExCLNI would have no impact on the survival of patients with surgically-treated ExHBDCs.

The true prognosis of resected distal cholangiocarcinoma

“…In the same regard, the current study systematically performed lymph node dissection and found that one‐half of patients had positive lymph node status, but the results did not confirm any impact of lymph node involvement on OS ( P = 0.38) or DFS (0.88). Similarly, Noji et al demonstrated that extracapsular lymph node involvement had no impact on the survival ( P = 0.418) of DCC after resection with curative intent . The results of the present study support several other independent risk factors associated with poor DFS: (i) male gender (HR = 3.29 [1.6–6.78], P = 0.001); (ii) need for organ resection (HR = 7.1 [2.17–23.23], P = 0.001); (iii) vascular invasion (HR = 2.71 [1.41–5.2]) P = 0.003); and (iv) abdominal infection following surgery (HR = 3.39 [1.46–7.88] P = 0.004).…”

A new prognostic scoring system using factors available preoperatively to predict survival after operative resection of perihilar cholangiocarcinoma

“…Previous reports have shown that lymph node metastases are the strongest prognostic factors for survival in perihilar cholangiocarcinoma 8,[14][15][16] . Predicting the N category in the preoperative period is a very important topic in perihilar cholangiocarcinoma.…”

“…Moreover, our data showed that PLR correlated with tumor extent and histopathologic grade in hilar cholangiocarcinoma, suggesting that PLR can reflect the degree of malignancy in this disease. In pancreatic cancer, one previous study reported that preoperative PLR represented a significant independent prognostic index and had prognostic value independent of tumor size and lymph node ratio 8,[14][15][16] .…”

“…Although several studies have described prognostic factors and staging systems for classification of biliary cancer, the majority of these factors are only available after surgical resection 1-4, 6-10, 12 , 13 . Many previous reports indicated that nodal metastasis was one of the strongest prognostic factors for survival of perihilar cholangiocarcinoma 8,[14][15][16] . However, our previous reports showed that, although nodal metastases are representative poor prognostic factors after surgery for perihilar cholangiocarcinoma, their positive predictive value in preoperative imaging study is quite low 17,18 .…”

Lymph node dissection in resectable perihilar cholangiocarcinoma: a systematic review

“…Overall 3986 patients with a median age of 66 (range 58-70) were described and 2128 patients (53%) suffered from perihilar cholangiocarcinoma ( Table 1). [12][13][14][15][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32] In addition, 11 studies reporting exclusively perihilar The median number of lymph node count was reported in all 20 studies ranging from 2-24 lymph nodes (Fig 2). In 60% of the studies (n=12) exclusively regional lymphadenectomy was described.…”