Impact of lymph node dissection on clinical outcomes of intrahepatic cholangiocarcinoma: Inverse probability of treatment weighting with survival analysis

Abstract

Background Lymph node metastasis (LNM) has been established as a critical risk factor for prognosis in intrahepatic cholangiocarcinoma (ICC). The clinical implications of lymph node dissection (LND) have been debated. This study aimed to clarify the prognostic impact of LND by multicenter retrospective analysis. Methods A total of 310 ICC patients who had undergone curative resection between 2000 and 2016 were retrospectively analyzed. The prognostic impact of LND was estimated under an inverse probability of treatment weighting (IPTW) approach using propensity scores. Results LND was performed for 224 patients (72%), with LNM pathologically confirmed in 90 patients (40%). Prognosis was poorer for patients with LNM (median survival, 16.9 months) than for those without (57.2 months; P < .0001). One‐, 3‐, and 5‐year overall survival rates (OS) were comparable among LND+ (81.6%, 48.0%, and 37.5%, respectively) and LND– groups (81.6%, 55.4%, and 44.6%, respectively). However, advanced tumor, as characterized by larger tumor, multinodular lesions, and serosal invasion, was significantly more frequent in the LND+ group than in the LND– group. After IPTW adjusting for imbalances, 1‐, 3‐, and 5‐year OS were better in the LND+ group (83.5%, 52.2%, and 42.8%, respectively) than in the LND– group (71.9%, 32.4%, and 23.4%, respectively; P = .046). LND thus showed significant prognostic impact (hazard ratio = 0.58, 95%CI = |0.39|–|0.84|, P = .005), especially in hilar ICC. However, peripheral ICC displayed no therapeutic benefit from LND. Conclusions LND could have a significant role to play in improving oncologic outcomes. Therapeutic LND should be implemented on the basis of tumor location and tumor advancement.

Tumor Burden Score Stratifies Prognosis of Patients With Intrahepatic Cholangiocarcinoma After Hepatic Resection: A Retrospective, Multi-Institutional Study

“…Patients with high TBS/high CA19-9 grade (CTC grade 3) had worst OS and RFS, whereas individuals with low TBS/low CA19-9 grade (CTC grade 1) were associated with best prognosis. MVI and lymph-node invasion have been established as critical risk factors for poor OS and RFS in ICC ( 35 , 36 ). In the present work, CTC grade demonstrated accurate predictive value in ICC patients following curative resection, better than MVI and lymph node invasion.…”

A Nomogram Model to Predict Early Recurrence of Patients With Intrahepatic Cholangiocarcinoma for Adjuvant Chemotherapy Guidance: A Multi-Institutional Analysis

“…In this study, CA19-9, tumor size, major vascular invasion, microvascular invasion, and N stage were identified as the independent risk factors for early recurrence, in which CA19-9 and N stage were the independent risk factors for OS and RFS of ICC patients after radical resection. Many studies ( 11 , 17 , 20 , 23 – 25 ) have proved that the above five variables were the independent risk factors for early recurrence and prognosis, which also provided a basis for establishing an effective predictive model.…”

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

“…This informational gap can be solved if prospective studies are carried out in the future. At the same time, patients with hilar invasion tend to have lymph node metastasis [ 36 ], but due to the limitations of our data, this part of the content has not been studied in depth. We hope that we can further improve the relevant content in the future.…”