Prognostic significance of and risk prediction model for lymph node metastasis in resectable intrahepatic cholangiocarcinoma: do all require lymph node dissection?

Navarro, Jonathan; Lee, Jin Ho; Kang, Il‐Mo; Rho, Seoung Yoon; Choi, Gi Hong; Han, Dai Hoon; Kim, Kyung Sik; Choi, Jin Sub

doi:10.1016/j.hpb.2020.01.009

Cited by 36 publications

(18 citation statements)

References 39 publications

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“…It is reported that the morbidity of ICC in male is 40-63.5% [14,[16][17][18], and the age at diagnosis is mainly in the 6th decade of life, but ranges from 21 to 86years [17][18][19][20]. Among the 68 cases in the current study, 50 were males accounting for 73.5% of the patients, which was higher than that reported in the literature.…”

Section: Discussioncontrasting

confidence: 58%

Clinical Outcomes of Mass-Forming Intrahepatic Cholangiocarcinoma: A Case Series of 68 Patients

Feng¹,

Liang²,

Zhao³

et al. 2020

JJGH

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1.1 Background: This study aims to examine the prognostic factors of patients with MF ICC in order to improve the outcomes of ICC. Methods:We carried out a retrospective analysis of consecutive patients with MF ICC treated at the Faculty of Hepato-Pancreato-Biliary Surgery of Chinese PLA General Hospital between January 2008 and December 2018. The patients were divided into the resection group and exploration group. Results:The 1-, 3-, and 5-year survival rates of the 68 cases in this study were 66.5%, 36.3%, and 9.3%, respectively. Univariate analyses revealed that the survival rates were significantly different according to nodal metastasis (P<0.001), vascular invasion (P<0.001), ascites (P<0.001), group (P<0.001), differentiation (P=0.009), and tumor location (P=0.032). Multivariate analysis demonstrated that ascites (HR=5.6, 95%CI: 1.6-18.9, P=0.006) and vascular invasion (HR=2.5, 95%CI: 1.0-6.1, P=0.045) were independent risk factors affecting the prognosis of the patients. Among patients who underwent surgical resection, the 1-, 3-, and 5-year survival rates of the 49 cases were 93.5%, 49.7%, and 14.4%, respectively. Univariate analyses showed that vascular invasion (P<0.001), nodal metastasis (P=0.001), and tumor size (P=0.044) were associated with survival. While vascular invasion (HR=3.1, 95% CI: 1.2-8.5, P=0.024) and nodal metastasis (HR=3.2, 95% CI: 1.4-7.6, P=0.008) were independently associated with survival. The 1-, 3-, and 5-year survival rates of the 19 cases in exploration group were 5.3%, 5.3%, and 0.0%, respectively. Conclusions:The prognosis of MF ICC was poor for patients with ascites or vascular invasion. Surgical resection is a key factor in improving survival. Vascular invasion and nodal metastasis affected the efficacy of surgical resection of MF ICC.

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Section: Discussioncontrasting

confidence: 58%

Clinical Outcomes of Mass-Forming Intrahepatic Cholangiocarcinoma: A Case Series of 68 Patients

Feng¹,

Liang²,

Zhao³

et al. 2020

JJGH

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“…A cutoff of 1 (i.e. LNM-positive and negative) has been shown to effectively differentiate the patients’ prognoses [ 10 , 12 , 20 , 30 – 33 ]. This conclusion was verified in our cohort.…”

Section: Discussionmentioning

confidence: 99%

The role of lymph node dissection in intrahepatic cholangiocarcinoma: a multicenter retrospective study

et al. 2021

BMC Surg

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Background Lymph node dissection (LND) is of great significance in intrahepatic cholangiocarcinoma (ICC). Although the National Comprehensive Cancer Network (NCCN) guidelines recommend routine LND in ICC, the effects of LND remains controversial. This study aimed to explore the role of LND and some related issues and of in ICC. Methods Patients were identified in two Chinese academic centers. Inverse probability of treatment weighting (IPTW) was used to reduce bias. Kaplan–Meier curves and Cox proportional hazards models were used to compare overall survival (OS) and disease-free survival (DFS). Results Of 232 patients, 177 (76.3%) underwent LND, and 71 (40.1%) had metastatic lymph nodes. A minimum of 6 lymph nodes were dissected in 66 patients (37.3%). LND did not improve the prognosis of ICC. LNM > 3 may have worse OS and DFS than LNM 1–3, especially in the LND > = 6 group. For patients who did not underwent LND, the adjuvant treatment group had better OS and DFS. Conclusions The proportions of patients who underwent LND and removed > = 6 lymph nodes were not high enough. LND has no definite predictive effect on prognosis. Patients with 4 or more LNMs may have a worse prognosis than patients with 1–3 LNMs. Adjuvant therapy may benefit patients of nLND.

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“…LNM positivity and negativity, which are defined as N0 and N1, have been proven to effectively differentiate the prognosis of ICC. 17,[24][25][26][27] The N stages for other bile duct cancers, namely extrahepatic cholangiocarcinoma, perihilar cholangiocarcinoma, and gallbladder carcinoma, are all graded with LNM numbers. 21 Nakagawa et al proposed a new N stage system: N0 (LNM 0), N1 (LNM 1-2), and N2 (LNM > 2), in 2005, in which survival of patients with N2 status was worse than that of patients with N1 status.…”

Section: Discussionmentioning

confidence: 99%

“…LNM positivity and negativity, which are defined as N0 and N1, have been proven to effectively differentiate the prognosis of ICC. 17,24–27 The N stages for other bile duct cancers, namely extrahepatic cholangiocarcinoma, perihilar cholangiocarcinoma, and gallbladder carcinoma, are all graded with LNM numbers. 21 Nakagawa et al.…”

Section: Discussionmentioning

confidence: 99%

The role of lymph node dissection and a new N-staging system for intrahepatic cholangiocarcinoma: a study from the SEER database

Zhao

Cai

2021

J Int Med Res

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Background Although the National Comprehensive Cancer Network guidelines recommend routine lymph node dissection (LND) in intrahepatic cholangiocarcinoma (ICC), the role of LND remains controversial, and the node (N) stage is oversimplified. Methods Patients were identified from the Surveillance, Epidemiology, and End Results research data 18 (SEER 18). Propensity score matching (PSM) was used to reduce bias, and Kaplan–Meier curves and Cox proportional hazards models were used to compare overall survival (OS). The best cutoff values were found using X-tile software. Results Of 2037 patients included in SEER 18, 1147 underwent LND (56.3%); 389 (34.3%) had pathologically confirmed lymph node metastasis (LNM), and 316 (27.6%) had at least 6 LNDs. The median OS was worse for LND patients (34 months vs. 40 months, respectively), and this result remained after PSM. Male sex, age ≥60 years, tumor size > 5 cm, and LNM were independent prognostic risk factors for ICC. LNM ≥3 was associated with worse OS. Conclusions Only a few LNDs met the requirements per the guidelines. LND does not improve OS in ICC, and the best approach to LND and a better N staging method should be explored further.

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Prognostic significance of and risk prediction model for lymph node metastasis in resectable intrahepatic cholangiocarcinoma: do all require lymph node dissection?

Cited by 36 publications

References 39 publications

Clinical Outcomes of Mass-Forming Intrahepatic Cholangiocarcinoma: A Case Series of 68 Patients

Clinical Outcomes of Mass-Forming Intrahepatic Cholangiocarcinoma: A Case Series of 68 Patients

The role of lymph node dissection in intrahepatic cholangiocarcinoma: a multicenter retrospective study

The role of lymph node dissection and a new N-staging system for intrahepatic cholangiocarcinoma: a study from the SEER database

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