Number of Lymph Node Metastases Is a Significant Prognostic Factor in Intrahepatic Cholangiocarcinoma

Abstract

Intrahepatic cholangiocarcinoma (IHCC) is a rare primary hepatic tumor. Outcomes after resection and the use of lymph node dissection have not been well described. From a prospective database, we identified 53 patients with IHCC who underwent exploration between April 1983 and March 2004. Hepatic resection was performed in 44 patients, 30 of whom underwent lymph node dissection. Clinicopathological features and outcomes were analyzed. The actuarial 1-year survival was 66.2% in resected patients, compared to 0% in unresectable patients (p < 0.0001), with a 50% overall survival of 21.5 months and 3.1 months, respectively. The actuarial 3-year and 5-year overall survival rates in resected patients were 38.3% and 26.3%, respectively. Univariate analysis revealed that factors associated with poor overall survival included multiple tumors, extrahepatic bile duct involvement, noncurative resection, and involvement of lymph nodes. Multivariate analysis in resected patients revealed that multiple tumors (p < 0.0074) and non-curative resection (p = 0.0068) were significant risk factors for poor overall survival. The survival rate in patients with three or more positive nodes was significantly lower than in those with fewer than three (p < 0.0001). Three patients with solitary tumors and one or two involved lymph nodes have survived beyond 4 years after extended lobectomy with systemic lymphadenectomy. Curative resection, single tumor, and fewer than two lymph node metastases were prognostic factors for good outcome. Curative resection with lymph node dissection improved survival in patients with no more than two positive lymph nodes.

AJCC 7th edition of TNM staging accurately discriminates outcomes of patients with resectable intrahepatic cholangiocarcinoma

“…However, this feature has been shown to have no survival impact and that omitting it actually improved the accuracy of staging. 27 Third, no attempt was made to further stratify Nþ patients according to the number of invaded LNs 28 or the LN ratio 29 because of the lack of standardization of LN harvesting. Finally, our strict inclusion criteria (complete clinical and pathological data sets and proven R0 resection) resulted in 69% of our patients being excluded from analysis.…”

The value of systematic lymph node dissection for intrahepatic cholangiocarcinoma from the viewpoint of liver lymphatics

“…Suzuki et al [35] recommended systematic LN dissection combined with hepatectomy for mass-forming type IHCC with only a single LN metastasis. Nakagawa et al [37] concluded that the indication for curative resection with systematic LN dissection was no more than two LN metastatic nodules. Consequently, it has been strongly suggested that this so-called systematic LN dissection is merely LN sampling under these circumstances, even if the extended systematic LN dissection had some prognostic meaning in a few previous reports regarding long-term survivors with LN metastasis.…”

Fibrolamellar carcinoma of the liver exhibits immunohistochemical evidence of both hepatocyte and bile duct differentiation

“…1,64,65 Half of our cases of fibrolamellar carcinoma had lymph node metastases compared with only 1 of 62 cases of hepatocellular carcinoma. Cholangiocarcinomas 66,67 and hepatoblastomas 68 also show higher rates of lymph node metastasis at surgery than hepatocellular carcinoma, suggesting a link between these tumors and fibrolamellar carcinomas. However, as our study and many others only include patients who underwent surgical resection, this does not accurately represent the rate of lymph node metastasis at presentation for these various tumors.…”