Impact of Positive Lymph Nodes and Resection Margin Status on the Overall Survival of Patients with Resected Perihilar Cholangiocarcinoma: The ENSCCA Registry

Abstract

Background: Lymph node metastasis and positive resection margins have been reported to be major determinants of overall survival (OS) and poor recurrence-free survival (RFS) for patients who underwent resection for perihilar cholangiocarcinoma (pCCA). However, the prognostic value of positive lymph nodes independently from resection margin status on OS has not been evaluated. Methods: From the European Cholangiocarcinoma (ENSCCA) registry, patients who underwent resection for pCCA between 1994 and 2021 were included in this retrospective cohort study. The primary outcome was OS stratified for resection margin and lymph node status. The secondary outcome was recurrence-free survival. Results: A total of 325 patients from 11 different centers and six European countries were included. Of these, 194 (59.7%) patients had negative resection margins. In 113 (34.8%) patients, positive lymph nodes were found. Lymph node status, histological grade, and ECOG performance status were independent prognostic factors for survival. The median OS for N0R0, N0R1, N+R0, and N+R1 was 38, 30, 18, and 12 months, respectively (p < 0.001). Conclusion: These data indicate that in the presence of positive regional lymph nodes, resection margin status does not determine OS or RFS in patients with pCCA. Achieving negative margins in patients with positive nodes should not come at the expense of more extensive surgery and associated higher mortality.

Insights for clinical management from the real-life data of the centralized West of Scotland biliary cancer clinic

“…29% of the whole cohort of BTC patients were eligible for curative surgery, of which 60% relapsed within 2 years. We confirmed that the most accurate prognostic factor for relapse was the lymph-nodal status, as previously reported [ 21 ]. Interestingly, we did observe a high correlation between positive nodal status and microscopic vascular invasion (93%), suggesting that in those cases where assessment of lymphoadenectomy is considered (i.e.…”

Adjuvant therapy of biliary tract cancers

“…There is a well-established emphasis on pathology in predicting likely outcomes by considering the recognised negative prognostic indicators of tumour size, positive resection margins and nodal involvement. 37 Lymph node involvement is independently associated with a high risk of early relapse and adequate lymphadenectomy should be standard in patients undergoing liver resection due to the survival benefit, even in clinically node negative iCCA. 38 Recently, Lamarca et al 39 proposed a modification to staging classifications to account for the significantly worse prognosis observed in iCCA if liver metastases present, irrespective of lymph node status.…”

Translational Value of Tumor-Associated Lymphangiogenesis in Cholangiocarcinoma

“…In line with these findings, an older study from Japan showed that hemi-hepatectomy associated with wide lymph node dissection, extended beyond the regional lymph nodes to the para-aortic site, had curative effects on the 5-year survival in iCCA [ 6 ]. Finally, a recent work based on the European Network for the Study of Cholangiocarcinoma (ENS-CCA) registry confirmed that in the case of positive lymph nodes, the state of the resection margin does not influence OS or recurrence-free survival (RFS) [ 7 ].…”