The clinical value of regional lymphadenectomy for intrahepatic cholangiocarcinoma

Abstract Objective: The aim of this study was to explore the clinical value of lymph node dissection (LND) for intrahepatic cholangiocarcinoma (ICC). Methods: Clinical and pathological data were collected from 147 ICC patients who attended two tertiary centers over the past 5 years. The patients were classified into two groups: the LND group (group A) and the no-performance LND (NLND) group (group B). Clinical and pathological parameters were compared between the two groups to analyze the impact of LND on the prognosis of ICC patients. Results: Of the 147 patients, 54.4% (80) received LND and 42.5% (34/80) of these were found to have lymph node metastasis (LNM) in postoperative pathological diagnosis. Patients undergoing LND usually have a larger surgical range, including hemihepatectomy and enlarged hemihepatectomy (P = 0.001). LND did not increase postoperative complications (27.5%, P = 0.354), but postoperative hospital stays were longer (12.2 ± 6.3 d, P = 0.005) in group A compared with group B (20.9%, 9.5 ± 3.5 d). The 5-year survival rates of groups A and B are almost similar (21% vs 29%, P=0.905). The overall survival rate of cN0 (diagnosis obtained by imaging) is better than pN1 (diagnosis obtained by histopathology), but lower than pN0. (all P < 0.05). Elevated CA19-9 level (HR = 1.764, 95% CI: 1.113 ~ 2.795 , P = 0.016), vascular invasion (HR = 2.697, 95% CI: 1.103 ~ 6.599, P = 0.030), and T staging (HR = 1.848, 95% CI: 1.059 ~ 3.224, P = 0.031) were independent risk factors for poor ICC prognosis (all P values > 0.05).Conclusion: ICC patients with cN0 may have LNM, and the prognosis of LNM patients is usually poor. Our data may support routine lymphadenectomy for ICC.

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Proposal of "Perihilar surrounding area" in relation to regional lymphadenectomy in selected patients with intrahepatic cholangiocarcinoma

International Surgery ◽

10.9738/intsurg-d-15-00267.1 ◽

2016 ◽

Author(s):

Naoto Gotohda ◽

Yuichiro Kato ◽

Shinichiro Takahashi ◽

Masaru Konishi

Keyword(s):

Lymph Node ◽

Retrospective Study ◽

Liver Resection ◽

Intrahepatic Cholangiocarcinoma ◽

Primary Tumor ◽

Extrahepatic Bile Duct ◽

Surrounding Area ◽

Primary Tumors ◽

Poor Prognostic Factor ◽

Regional Lymphadenectomy

Abstract Objectives and BackgroundãLymph node (LN) metastasis is well recognized as a poor prognostic factor in intrahepatic cholangiocarcinoma (ICC), however, the efficacy of LN dissection for ICC remains unclear. We clarify a targeted papulation of ICC to evaluate it in this study. MethodsãA retrospective study of patients who underwent liver resection without the extrahepatic bile duct for ICC was conducted. The pattern of LN recurrence and the location of the primary tumor were evaluated. ResultsãBetween January 2003 and July 2014, 52 patients with ICC underwent surgery. Fourteen patients had LN recurrence, of whom 6 patients had LN recurrence only. Excluding patients with LN dissection at surgery, the primary tumor was limited to the perihilar surrounding area in patients with LN recurrence only. Recurrence rate in LNs was 50% in patients with primary tumors originating in the perihilar surrounding area, which was significantly higher than the rate of 13% in patients with primary tumors originating in other areas. ConclusionsãPrimary tumors in the perihilar surrounding area have a high risk of LN recurrence. Regional lymphadenectomy combined with hepatectomy should be carried out in patients with ICC located in this area. The incidence of LN metastasis and the possibility of preventing LN recurrence could be effectively revealed by regional lymphadenectomy in selected patients.

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Intrahepatic Cholangiocarcinoma

10.2310/7800.16062 ◽

2019 ◽

Author(s):

Jordan M Cloyd ◽

Timothy M. Pawlik

Keyword(s):

Intrahepatic Cholangiocarcinoma ◽

Recurrence Rates ◽

Liver Malignancies ◽

Curative Intent ◽

Prospective Data ◽

Liver Remnant ◽

Tract Cancer ◽

Regional Lymphadenectomy ◽

Localized Disease ◽

And Function

Intrahepatic cholangiocarcinoma is an aggressive malignancy. For patients who present with localized disease, surgical resection remains the only potentially curative treatment. Similar to the treatment of other liver malignancies, the principle surgical approach for iCCA should be a margin-negative hepatic resection with preservation of a liver remnant of adequate size and function. Regional lymphadenectomy is recommended at the time of hepatectomy due to the importance of nodal involvement on staging and prognosis. Given the substantial recurrence rates observed even after curative-intent resection, perioperative systemic therapy may have value, with recent prospective data suggesting adjuvant capecitabine may be the standard therapy recommended for most patients. For those with metastatic or unresectable disease, systemic chemotherapy and locoregional modalities are recommended. In the future, improved understanding of the genetic and molecular underpinnings of iCCA tumorigenesis will lead to improved targeted therapies and better outcomes for these patients. This review contains 4 figures, 1 table and 35 references. Key Words: biliary tract cancer, chemotherapy, hepatectomy, intrahepatic cholangiocarcinoma, Klatskin, liver cancer, liver resection, lymphadenectomy, vascular resection

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A High-Accuracy Model Based on Plasma miRNAs Diagnoses Intrahepatic Cholangiocarcinoma: A Single Center with 1001 Samples

Diagnostics ◽

10.3390/diagnostics11040610 ◽

2021 ◽

Vol 11 (4) ◽

pp. 610

Author(s):

Jie Hu ◽

Yi-Ning Wang ◽

Dan-Jun Song ◽

Jin-Peng Tan ◽

Ya Cao ◽

...

Keyword(s):

Intrahepatic Cholangiocarcinoma ◽

Validation Cohort ◽

Liver Tumors ◽

Characteristic Curve ◽

Diagnostic Value ◽

High Accuracy ◽

Clinical Value ◽

Malignant Liver Tumors ◽

Malignant Liver ◽

Performance Results

Objectives: Intrahepatic cholangiocarcinoma (iCCA) is a highly malignant cancer. More than 70% of patients are diagnosed at an advanced stage. The aim of this study was to evaluate the diagnostic value of plasma miR-21, miR-122, and CA19-9, hoping to establish a novel model to improve the accuracy for diagnosing iCCA. Materials and methods: Plasma miR-21 and miR-122 were detected in 359 iCCA patients and 642 controls (healthy, benign liver lesions, other malignant liver tumors). All 1001 samples were allocated to training cohort (n = 668) and validation cohort (n = 333) in a chronological order. A logistic regression model was applied to combine these markers. Area under the receiver operating characteristic curve (AUC) was used as an accuracy index to evaluate the diagnostic performance. Results: Plasma miR-21 and miR-122 were significantly higher in iCCA patients than those in controls. Higher plasma miR-21 level was significantly correlated with larger tumor size (p = 0.030). A three-marker model was constructed by using miR-21, miR-122 and CA19-9, which showed an AUC of 0.853 (95% CI: 0.824–0.879; sensitivity: 73.0%, specificity: 87.4%) to differentiate iCCA from controls. These results were subsequently confirmed in the validation cohort with an AUC of 0.866 (0.825–0.901). The results were similar for diagnosing early (stages 0–I) iCCA patients (AUC: 0.848) and CA19-9negative iCCA patients (AUC: 0.795). Conclusions: We established a novel three-marker model with a high accuracy based on a large number of participants to differentiate iCCA from controls. This model showed a great clinical value especially for the diagnosis of early iCCA and CA19-9negative iCCA.

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The clinical value of Fibulin-1 for prognosis and its prospective mechanism in intrahepatic cholangiocarcinoma

HPB ◽

10.1016/j.hpb.2018.09.002 ◽

2019 ◽

Vol 21 (4) ◽

pp. 499-507 ◽

Cited By ~ 2

Author(s):

Yusheng Jie ◽

Jiao Gong ◽

Cuicui Xiao ◽

Jun Zheng ◽

Zhiwei Zhang ◽

...

Keyword(s):

Intrahepatic Cholangiocarcinoma ◽

Clinical Value

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Intrahepatic Cholangiocarcinoma

10.2310/cgso.16062 ◽

2019 ◽

Author(s):

Jordan M Cloyd ◽

Timothy M. Pawlik

Keyword(s):

Intrahepatic Cholangiocarcinoma ◽

Recurrence Rates ◽

Liver Malignancies ◽

Curative Intent ◽

Prospective Data ◽

Liver Remnant ◽

Tract Cancer ◽

Regional Lymphadenectomy ◽

Localized Disease ◽

And Function

Intrahepatic cholangiocarcinoma is an aggressive malignancy. For patients who present with localized disease, surgical resection remains the only potentially curative treatment. Similar to the treatment of other liver malignancies, the principle surgical approach for iCCA should be a margin-negative hepatic resection with preservation of a liver remnant of adequate size and function. Regional lymphadenectomy is recommended at the time of hepatectomy due to the importance of nodal involvement on staging and prognosis. Given the substantial recurrence rates observed even after curative-intent resection, perioperative systemic therapy may have value, with recent prospective data suggesting adjuvant capecitabine may be the standard therapy recommended for most patients. For those with metastatic or unresectable disease, systemic chemotherapy and locoregional modalities are recommended. In the future, improved understanding of the genetic and molecular underpinnings of iCCA tumorigenesis will lead to improved targeted therapies and better outcomes for these patients. This review contains 4 figures, 1 table and 35 references. Key Words: biliary tract cancer, chemotherapy, hepatectomy, intrahepatic cholangiocarcinoma, Klatskin, liver cancer, liver resection, lymphadenectomy, vascular resection

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