Evaluation of prognostic factors and implication of lymph node dissection in intrahepatic cholangiocarcinoma: 10-year experience at a tertiary referral center

Chang, Miao-Erh; Lei, Hao‐Jan; Chen, Ming-Huang; Yeh, Yi‐Chen; Li, Chung–Pin; Hung, Yi‐Ping; Hsia, Cheng Yuan; Liu, Chieu-An; Chau, Gar‐Yang; Chao, Yee

doi:10.1016/j.jcma.2016.09.010

Cited by 20 publications

(19 citation statements)

References 27 publications

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“…Most of cLNM-negative patients (80%) showed consistent diagnosis after final pathologic evaluations. And we found cLNM-negative ICC patients showed almost the same survival rate when compared with pLNM-negative ICC patients, this result similar with literature report [ 21 , 22 ]. Besides, with the development of imaging system, the accuracy of LNM detection by preoperative imaging examination has been improving in recent years [ 23 , 24 ].…”

Section: Discussionsupporting

confidence: 91%

Intrahepatic cholangiocarcinoma patients without indications of lymph node metastasis not benefit from lymph node dissection

Chen

Zhou

et al. 2017

Oncotarget

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Background: To investigate the necessity of routine lymph node dissection (LND) in intrahepatic cholangiocarcinoma (ICC) patients without indications of lymph node metastasis (LNM) preoperatively. Methods: 422 consecutive ICC patients who undergone curative resection from January 2009 to December 2014 were enrolled and categorized as two groups (hepatectomy only or hepatectomy plus LND). Clinicopathologic data was compared between the groups by χ2 or Fisher’s exact test. Overall survival (OS) and recurrence-free survival (RFS) were calculated by the Kaplan–Meier method and differences were analyzed using the log-rank test. Cox regression model was adopted for multivariable analysis. Results: The median OS time of all 422 patients was 41.4 months. One-, 3-, and 5-year OS was 67%, 47%, and 35%, respectively. A total of 73 patients had undergone curative resection combined with LND, of whom 20.5% (15/73) were confirmed lymph node positive pathologically. The clinicopathologic characteristics between LND and control groups showed no significant differences. Of the 422 patients, 271 patients had recurrence. The recurrence rates were 65.8% for the LND group and 63.9% for the non-LND group. Survival analysis revealed that, neither the OS (LND vs. non-LND: 32.2 months vs. 46.2 months; p = 0.16) nor the RFS (LND vs. non-LND: 23.1 months vs. 17.0 months; p = 0.09) had significant difference. Multivariate analysis revealed that tumor size, tumor number, carbohydrate antigen19-9, carcinoembryonic antigen, and gamma-glutamyl transpeptidase were independent predictive factors for OS and RFS. Conclusion: Routine LND may not improve survival in resectable ICC patients with negative LNM diagnosis before operation.

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Section: Discussionsupporting

confidence: 91%

Intrahepatic cholangiocarcinoma patients without indications of lymph node metastasis not benefit from lymph node dissection

Chen

Zhou

et al. 2017

Oncotarget

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“…Moreover, independent factors associated with decrease DFS were tumor size > 5 cm, periductal infiltrating growth type tumor, multiple tumor, vascular invasion, and lymph node metastasis. These factors, however, had been demonstrated as important determinant of OS and DFS in different studies [5,6,17,[21][22][23].…”

Section: Discussionmentioning

confidence: 99%

Prognostic Significance and Predictive Factors of Lymph Node Metastasis in Resectable Intrahepatic Cholangiocarcinoma

GH¹

2019

Austin J Surg

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Background: Lymph node metastasis portend a worse prognosis following resection of Intrahepatic Cholangiocarcinoma (ICC); however, the role of lymphadenectomy is still controversial and not routinely performed. In this study, we investigated the oncologic significance and predictive factors of lymph node metastasis in patients with ICC, which can potentially influence decision making for the patient's oncologic benefit with lymphadenectomy. Materials and Methods:We retrospectively reviewed patients who underwent curative-intent surgery for intrahepatic cholangiocarcinoma between 2001 and 2014. The data was collected from the electronic medical record database of the hospital.Results: A total of 168 patients were included in the study. Multivariable analysis revealed that: age >65 years, lymph node metastasis, tumor size >5 cm and periductal infiltrating tumor morphology, were independently associated with poor OS (P<0.05); moreover, tumor size >5 cm, periductal infiltrating tumor morphology, multiple tumor, vascular invasion, and lymph node metastasis, were independently associated with increased risk of tumor recurrence (P<0.05). The CT finding of enlarged lymph nodes and CA 19-9 >120 IU/ml were preoperative predictors for lymph node metastasis; however, the sensitivity and specificity were only 62.5% and 88.0%, respectively, to identify lymph node metastasis. Conclusion:Lymph node metastasis is associated with poor overall survival and disease-free survival following curative-intent resection in patients with ICC. Routine lymph node dissection for preoperatively diagnosed ICC should be recommended to properly assess the lymph node status of patients with ICC.

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“…It has been also demonstrated that liver-specific deletion of PTEN in a mouse model results in the development of ICC (26,27). As an important tumor suppressor, PTEN mainly acts to dephosphorylate phosphatidylinositol-3,4,5-trisphosphate [PtdIns (3,4,5) P3], which potently activates 3-phosphoinositide-dependent kinase (PDK) and protein kinase B (AKT) (28). However, PTEN loss leads to excessive recruitment of PtdIns (3,4,5)P3 at the plasma membrane, thereby activating a subset of proteins, including the AKT family and PDK1 (28).…”

Section: Discussionmentioning

confidence: 99%

“…As an important tumor suppressor, PTEN mainly acts to dephosphorylate phosphatidylinositol-3,4,5-trisphosphate [PtdIns (3,4,5) P3], which potently activates 3-phosphoinositide-dependent kinase (PDK) and protein kinase B (AKT) (28). However, PTEN loss leads to excessive recruitment of PtdIns (3,4,5)P3 at the plasma membrane, thereby activating a subset of proteins, including the AKT family and PDK1 (28). AKT signaling induces cell survival, cell proliferation, angiogenesis and cellular metabolism via phosphorylating downstream signaling proteins (29,30).…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies have suggested that multiple signaling pathways are involved in the progression of ICC (3,4); however, the specific mechanisms underlying ICC etiology remain unknown. As cystoscopy is invasive and expensive, there is a need to identify potential diagnostic biomarkers for ICC in order to improve the early detection of ICC (5,6).…”

Section: Introductionmentioning

confidence: 99%

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Enhanced plasma miR‑142‑5p promotes the progression of intrahepatic cholangiocarcinoma via targeting PTEN

Wei

Yuan

et al. 2019

Exp Ther Med

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The aim of the present study was to evaluate the expression and specific role of microRNA (miR)-142-5p in the progression of intrahepatic cholangiocarcinoma (ICC). Reverse transcription-quantitative polymerase chain reaction was performed to evaluate miR-142-5p expression in patients with ICC and healthy control subjects. The results revealed that plasma miR-142-5p was significantly increased in patients with ICC compared with the control group. Furthermore, miR-142-5p was also increased in ICC tissues compared with adjacent non-neoplastic tissues. Compared with patients with Ta-T1 stage ICC, miR-142-5p was significantly elevated in patients with ICC ≥T2 stage. Patients with ICC at G3 stage had much higher plasma miR-142-5p levels compared with those at G1/2 stage. Receiver operating characteristic analysis indicated that miR-142-5p could be used as a biomarker to differentiate patients with ICC from healthy controls. Kaplan-Meier analysis demonstrated that plasma miR-142-5p was negatively correlated with survival in patients with ICC. A dual luciferase reporter assay indicated that miR-142-5p significantly suppressed the relative luciferase activity of pmirGLO-PTEN-3' untranslated region compared with the control group. In summary, the results of the present study provide novel data indicating that plasma miR-142-5p is significantly upregulated in patients with ICC. miR-142-5p may therefore have potential as a biomarker for screening patients with ICC from healthy controls.

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Evaluation of prognostic factors and implication of lymph node dissection in intrahepatic cholangiocarcinoma: 10-year experience at a tertiary referral center

Cited by 20 publications

References 27 publications

Intrahepatic cholangiocarcinoma patients without indications of lymph node metastasis not benefit from lymph node dissection

Intrahepatic cholangiocarcinoma patients without indications of lymph node metastasis not benefit from lymph node dissection

Prognostic Significance and Predictive Factors of Lymph Node Metastasis in Resectable Intrahepatic Cholangiocarcinoma

Enhanced plasma miR‑142‑5p promotes the progression of intrahepatic cholangiocarcinoma via targeting PTEN

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