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

Abstract

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.