Prognostic impact of lymph node parameters in distal cholangiocarcinoma after pancreaticoduodenectomy

Abstract

Background Pancreaticoduodenectomy is the only definitively curative therapy for the long-term survival of distal cholangiocarcinoma patients. Lymph node metastasis is widely accepted as an important prognostic factor for distal cholangiocarcinoma. The latest American Joint Committee on Cancer (AJCC) TNM classification system for distal cholangiocarcinoma has divided the lymph node metastasis patients into N1 and N2 by lymph node metastasis number. However, some studies suggested that the lymph node metastasis ratio may be better than the lymph node metastasis number. Therefore, we develop a program to analyze the correlation between lymph node parameters (lymph node dissection number, lymph node metastasis number, and lymph node metastasis rate) and long-term prognosis. Methods We retrospectively reviewed 123 distal cholangiocarcinoma patients after pancreatoduodenectomy from January 2011 to December 2019. The patients were grouped according to lymph node metastases and tumor-free and overall survival rates which were investigated with the Kaplan-Meier analysis. The logistic regression models were used for multivariate analysis to determine the risk factors for lymph node metastases. And the X-tile program was used to calculate the cutoff values for the lymph node parameters that discriminated survival. Results The 1-year, 3-year, and 5-year overall survival rates of patients with distal cholangiocarcinoma after pancreatoduodenectomy were 75.2%, 37.1%, and 31.5%, respectively. And the 1-year, 3-year, and 5-year overall survival rates of patients without and with lymph node metastasis were 83.0%, 50.7%, and 42.5% and 63.5%, 19.0%, and 19.0% (p = 0.000), respectively. Logistic regression showed CA19-9 and portal vein system invasion as independent risk factors for lymph node metastases. The receiver operating characteristic curve showed the optimal cutoff value of CA19-9 to predict the lymph node metastases was 75.5 U/mL. Determined by the X-tile software, the optimal cutoff values of the lymph node dissection number were 24 (p = 0.021), the lymph node metastasis number were 1 and 7 (p = 0.504), and the lymph node metastasis rate were 0.13 (p = 0.002). Conclusion Lymph node metastasis is an important factor affecting the long-term survival of distal cholangiocarcinoma patients.CA19-9 and portal vein system invasion are independent risk factors for lymph node metastasis. Besides, the lymph node dissection number and lymph node metastasis rate can predict the long-term survival better than lymph node metastasis number.

The prognostic value of the lymph node ratio in patients with distal cholangiocarcinoma after curative intended surgery: A single-center retrospective study

“…The median OS time was 31 months and the 5-year survival rate was 18%. Lyu et al [ 19 ] reviewed the data of 123 patients with DCC after PD in a single center in China. The 5-year OS rate was 31.5%.…”

Comparison of Four Lymph Node Stage Methods for Predicting the Prognosis of Distal Cholangiocarcinoma Patients After Surgery

“…In the 7th edition of the AJCC TNM staging system, the N staging is mainly distinguished by the presence of regional lymph node metastasis. Several studies have confirmed that the number of regional PLNN can reflect the effect of lymph node metastasis on the prognosis of dCCA better when compared with the presence of lymph node metastases alone ( 26 – 30 ). The other two retrospective studies also found that patients with more than 11 lymph nodes removed had a better prognosis ( 31 , 32 ).…”

“…The LNR staging system combined with ELNN and PLNN compensates for the impact of insufficient ELNN on staging. A meta-analysis found that LNR = 0.2 is the ideal cutoff value for risk stratification of dCCA patients with radical resection ( 4 ), while the optimal cutoff value based on prognosis was between 0.45 and 0.17 ( 11 , 12 , 29 , 30 ). Similar cutoff values were obtained in our study by using X-tile software: LNR1-3: <0.1, 0.1 to 0.3, and ≥0.3.…”

The Impact of Intraoperative Frozen Section on Resection Margin Status and Survival of Patients Underwent Pancreatoduodenectomy for Distal Cholangiocarcinoma

“…In a study by Tsukahara et al, they demonstrated the survival rate of seven patients achieved R0 status after additional resection (sR0) was similar to that of pR0, and suggested additional resection was beneficial to some selected patients with positive margin of carcinoma in situ (CIS) (30). There were many series investigating prognostic factors of surgically treated dCCA patients, and the commonly identified factors were lymph node invasion, pancreatic invasion, perineural invasion, resection margin status, tumor grade, blood transfusion and adjuvant therapy (8,10,13,29,(31)(32)(33).…”