Ann Surg Treat Res.  2023 May;104(5):258-268. 10.4174/astr.2023.104.5.258.

The influence of the extent of lymph node metastasis on the prognosis for patients with intrahepatic cholangiocarcinoma

• Wang J
• Shu M
• Peng H
• Li S
• Li D
• Shen J
• Kuang M
• Zhang Y
• Chen Z

• KMID: 2542232
• DOI: http://doi.org/10.4174/astr.2023.104.5.258

Abstract

Purpose
Reports showed that some of intrahepatic cholangiocarcinoma (ICC) patients with lymph node metastasis (LNM) may also gain survival benefit undergone resection. However, the effect of the extent of LNM on prognosis and surgical indication is barely discussed.
Methods
From September 1994 to November 2018, primary ICC patients undergone initial curable surgery were enrolled. Based on the extent of LNM, we divided these patients into 4 groups, including patients with no LNM (group N0), LNM to hepatoduodenal ligament or common hepatic artery (region A, group A), LNM to gastrohepatic lymph nodes for left liver ICC and periduodenal and peripancreatic lymph node for right liver ICC (region B, group B), or LNM beyond these regions (region C, group C). Multivariable Cox regression analysis was performed to identify the prognostic factors for recurrencefree survival (RFS) and overall survival (OS) in all groups.
Results
A total of 133 patients were enrolled. There were 56, 21, 17, and 39 patients in groups N0, A, B, and C, respectively. There was significant difference between groups N0 and C in RFS (P < 0.001) and OS (P = 0.002). When we compared group N0 + A + B with group C, we also found that RFS (P < 0.001) and OS (P = 0.007) were significantly different. In multivariable analysis, the extent of LNM was an independent risk factor for RFS (P < 0.050).
Conclusion
ICC patients with the LNM to regions A and B could still achieve good prognosis with resection. Surgery should be carefully considered when LNM to region C.

Keyword

Cholangiocarcinoma; Lymphatic metastasis; Surgery

Figure

• 

  Fig. 1 Kaplan-Meier survival curves of patients in groups N0 (n = 56) and N1 (group A + B + C) (n = 77). (A) Recurrence-free survival (RFS) for patients in groups N0 and N1 (P = 0.003). (B) Overall survival (OS) for patients in groups N0 and N1 (P = 0.019).

• 

  Fig. 2 Kaplan-Meier survival curves of patients in groups N0 (n = 56) and C (n = 39). (A) Recurrence-free survival (RFS) for patients in groups N0 and C (P < 0.001). (B) Overall survival (OS) for patients in groups N0 and C (P = 0.002).

• 

  Fig. 3 Kaplan-Meier survival curves of patients in groups N0 + A + B (n = 94) and C (n = 39). (A) Recurrence-free survival (RFS) for patients in groups N0 + A + B and C (P < 0.001). (B) Overall survival (OS) for patients in groups N0 + A + B and C (P = 0.007).

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