Prognostic Value of Lymph Node Dissection for Intrahepatic Cholangiocarcinoma Patients With Clinically Negative Lymph Node Metastasis: A Multi-Center Study From China

Abstract

BackgroundThe clinical value of lymph-node dissection (LND) for intrahepatic carcinoma (ICC) patients with clinically negative lymph node metastasis (LNM) remains unclear; hence we conducted a multi-center study to explore it.MethodsPatients who were diagnosed ICC with clinically negative LNM and underwent hepatectomy with or without LND from December 2012 to December 2015 were retrospectively collected from 12 hepatobiliary centers in China. Overall survival (OS) was analyzed using the Kaplan–Meier method, and then subgroup analysis was conducted stratified by variables related to the prognosis.ResultsA total of 380 patients were eligible including 106 (27.9%) in the LND group and 274 (72.1%) in the non-LND group. Median OS in the LND group was slightly longer than that in the non-LND group (24.0 vs. 18.0 months, P = 0.30), but a significant difference was observed between the two groups (24.0 vs. 14.0 months, P = 0.02) after a well-designed 1:1 propensity score matching without increased severe complications. And, LND was identified to be one of the independent risk factors of OS (HR = 0.66, 95%CI = 0.46–0.95, P = 0.025). Subgroup analysis in the matched cohort showed that patients could benefit more from LND if they were male, age <60 years, had no HBV infection, with ECOG score <2, CEA ≤5 ug/L, blood loss ≤400 ml, transfusion, major hepatectomy, resection margin ≥1 cm, tumor size >5 cm, single tumor, mass-forming, no satellite, no MVI, and no perineural invasion (all P < 0.05). Furthermore, only patients with pathologically confirmed positive LNM were found to benefit from postoperative adjuvant therapy (P < 0.001).ConclusionWith the current data, we concluded that LND would benefit the selected ICC patients with clinically negative LNM and might guide the postoperative management.

Evaluation of nodal status in intrahepatic cholangiocarcinoma: a population-based study

“…In this context, to determine the minimally required TLNC, it is important to find potential positive lymph nodes and control surgical trauma. The current AJCC staging system (8 th edition) recommends that 6 or more lymph nodes be examined, but only 22.1% of patients in this study could meet this criterion and receive an adequate evaluation, which was similar to other studies (10,13,(17)(18)(19)(20)(21). The increased TLNC is indicative of a decreased sensitivity and an increased specificity in finding positive lymph nodes.…”

“…LNM presents more aggressive biological behavior, and it has been confirmed as an independent predictive factor for prognosis by multivariate analysis. However, unlike other biliary cancers, the role of LND is still a topic of debate in ICC (9)(10)(11)(12)(13)(14).…”

“…Lymph node metastasis (LNM) has been considered one of ICC's most widely accepted prognostic factors. However, the therapeutic value of regional lymph node dissection (LND) is still controversial (9)(10)(11)(12)(13)(14). Several studies demonstrated no benefits of routine LND because of the similar survival, prolonged hospital-stays and increased surgical risks compared with patients not receiving LND (11,(13)(14)(15)(16)(17)(18).…”

“…In addition, the minimum requirements of the total lymph node count (TLNC) also remain a matter of debate. The current American Joint Committee on Cancer (AJCC) staging system (8 th edition) recommends having 6 or more lymph nodes to be eligible for evaluation, but only a few patients could meet this criterion in previous studies (23.8-43.3%) (10,13,(17)(18)(19)(20)(21). In this context, the first aim of this study is to investigate the role and minimum requirement of LND in patients with ICC.…”

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

“…Nevertheless, there has been debate as to whether tumor size performs well in terms of prognostic stratification for ICC. Previous studies have indicated that tumor size could not serve as independent risk factor for prognostic prediction in ICC patients ( 24 , 25 ), while Beetz et al. demonstrated that patients with “very early” ICC (based on tumor size alone) displayed a promising postoperative 5-year survival rate of 58.2% ( 26 ).…”