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

Abstract

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.

Significance of Lymph Node Metastasis in the Treatment of Gastric Cancer and Current Challenges in Determining the Extent of Metastasis

“…The Z0011 study demonstrated that additional axillary nodal dissection after sentinel node biopsy does not improve prognosis in patients with breast cancer (28)(29)(30). Similarly, in many carcinomas, lymph node metastasis is thought to be important for accurate staging, but prophylactic nodal dissection does not improve prognosis (31)(32)(33)(34)(35). In contrast, the therapeutic effect of prophylactic lymph node dissection in patients with gastric cancer has been verified.…”

Preoperative prediction of intrahepatic cholangiocarcinoma lymph node metastasis by means of machine learning: a multicenter study in China

“…Intrahepatic cholangiocarcinoma (ICC) is a rare and fatal disease [ 2 , 5 ], and lymph node metastasis associated with this condition is an independent risk factor that affects the prognosis of ICC patients [ 20 ], and the choice of surgical methods for treatment [ 21 ]. The vast majority of related studies in this realm used logistic regression to screen risk factors and then established nomograms to try to predict lymph node metastasis [ 22 , 23 ].…”

“…Therefore, in the future, if the sample size can be expanded and data from large scale international centers can be included, our machine learning method can be improved to make more accurate predictions. Previous studies have shown that ICC patients with lymph node metastases tend to have poor survival rates [ 7 , 20 ]. However, due to a lack of follow-up data, a detailed survival analysis of predicted patients could not be performed in this study.…”

Case report: Conversion therapy for advanced intrahepatic cholangiocarcinoma using PD-1 inhibitor plus S-1 and nab-paclitaxel

“…recommended that at least lymph node stations 8 and 12 should be dissected irrespective of the tumor location. Although LND is effective for evaluation of nodal status, studies are becoming increasingly skeptical about the benefits of LND for prognostication ( 33 – 35 ). To date, routine LND remains controversial; however, a multi-center study shows that selected patients with iCCA could benefit from LND ( 36 ).…”