Problems of Lymph Node Dissection in Intrahepatic Cholangiocarcinoma: A Multicenter Retrospective Study Using Inverse Probability of Treatment Weighting.

Abstract Background Lymph node dissection (LND) is considered to improve the prognosis of patients with intrahepatic cholangiocarcinoma (ICC). Although the National Comprehensive Cancer Network (NCCN) guidelines recommend routine LND in ICC, the role of LND remains controversial. This study aimed to explore the effect of LND on the prognosis of patients with ICC from two Chinese centers.MethodsPatients were identified in two Chinese academic centers. Inverse probability of treatment weighting (IPTW) was used to reduce bias. Kaplan–Meier curves and Cox proportional hazards models were used to compare overall survival (OS) and disease-free survival (DFS).ResultsOf 251 patients, 189 (75.2%) underwent LND, and 72 (38%) had metastatic lymph nodes. A minimum of 6 lymph nodes were dissected in 67 patients (35.5%). Lymph node metastasis (LNM) was a risk factor with a high hazard ratio. There was no association between LND and OS after IPTW; however, LND may affect the DFS. Tumors in the LNM group were more malignant, and surgical trauma was greater in the LNM group.ConclusionsOnly a few LNDs meet the NCCN guidelines’ requirements. LND did not improve prognosis, with higher surgical trauma. The best approach for LND requires further discussion.

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The role of lymph node dissection in intrahepatic cholangiocarcinoma: a multicenter retrospective study

BMC Surgery ◽

10.1186/s12893-021-01363-4 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Hanjie Hu ◽

Gang Xu ◽

Shunda Du ◽

Zhiwen Luo ◽

Hong Zhao ◽

...

Keyword(s):

Lymph Node ◽

Lymph Nodes ◽

Lymph Node Dissection ◽

Intrahepatic Cholangiocarcinoma ◽

Proportional Hazards ◽

Disease Free Survival ◽

Cox Proportional Hazards ◽

Node Dissection ◽

Nccn Guidelines

Abstract Background Lymph node dissection (LND) is of great significance in intrahepatic cholangiocarcinoma (ICC). Although the National Comprehensive Cancer Network (NCCN) guidelines recommend routine LND in ICC, the effects of LND remains controversial. This study aimed to explore the role of LND and some related issues and of in ICC. Methods Patients were identified in two Chinese academic centers. Inverse probability of treatment weighting (IPTW) was used to reduce bias. Kaplan–Meier curves and Cox proportional hazards models were used to compare overall survival (OS) and disease-free survival (DFS). Results Of 232 patients, 177 (76.3%) underwent LND, and 71 (40.1%) had metastatic lymph nodes. A minimum of 6 lymph nodes were dissected in 66 patients (37.3%). LND did not improve the prognosis of ICC. LNM > 3 may have worse OS and DFS than LNM 1–3, especially in the LND > = 6 group. For patients who did not underwent LND, the adjuvant treatment group had better OS and DFS. Conclusions The proportions of patients who underwent LND and removed > = 6 lymph nodes were not high enough. LND has no definite predictive effect on prognosis. Patients with 4 or more LNMs may have a worse prognosis than patients with 1–3 LNMs. Adjuvant therapy may benefit patients of nLND.

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The Role of Lymph Node Dissection in Intrahepatic Cholangiocarcinoma: A Multicenter Retrospective Study.

10.21203/rs.3.rs-524332/v1 ◽

2021 ◽

Author(s):

Hanjie Hu ◽

Gang Xu ◽

Shunda Du ◽

Zhiwen Luo ◽

Hong Zhao ◽

...

Keyword(s):

Risk Factors ◽

Lymph Node ◽

Lymph Nodes ◽

Lymph Node Dissection ◽

Intrahepatic Cholangiocarcinoma ◽

Surgical Margin ◽

Disease Free Survival ◽

Positive Surgical Margin ◽

Node Dissection ◽

Independent Risk Factors

Abstract BackgroundLymph node dissection (LND) is of great significance in intrahepatic cholangiocarcinoma (ICC). Although the National Comprehensive Cancer Network (NCCN) guidelines recommend routine LND in ICC, the effects of LND remains controversial. This study aimed to explore the role and application of LND in ICC.MethodsPatients were identified in two Chinese academic centers. Inverse probability of treatment weighting (IPTW) was used to reduce bias. Kaplan–Meier curves and Cox proportional hazards models were used to compare overall survival (OS) and disease-free survival (DFS).ResultsOf 232 patients, 177 (76.3%) underwent LND, and 71 (40.1%) had metastatic lymph nodes. A minimum of 6 lymph nodes were dissected in 66 patients (37.3%). LND did not improve the prognosis of ICC. LNM >3 may have worse OS and DFS than LNM 1-3, especially in the LND >=6 group. For nLND patients, the adjuvant treatment group had better OS and DFS.ConclusionsCA 19-9, CEA, operative time, positive surgical margin, and T stage were independent risk factors for OS; CEA and differentiation were independent risk factors for DFS. LND has no definite predictive effect on prognosis. Patients with 4 or more LNMs may have a worse prognosis than patients with 1-3 LNMs. Adjuvant therapy may benefit patients of nLND.

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Role of lymph node dissection for intrahepatic cholangiocarcinoma.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.4_suppl.457 ◽

2017 ◽

Vol 35 (4_suppl) ◽

pp. 457-457

Author(s):

Taizo Hibi ◽

Yusuke Takemura ◽

Osamu Itano ◽

Masahiro Shinoda ◽

Minoru Kitago ◽

...

Keyword(s):

Lymph Node ◽

Lymph Nodes ◽

Lymph Node Dissection ◽

Intrahepatic Cholangiocarcinoma ◽

Lymph Node Metastases ◽

Node Dissection ◽

Dominant Type ◽

R1 Resection ◽

Node Metastases

457 Background: The prognosis of intrahepatic cholangiocarcinoma (ICC) with lymph node metastases is dismal. Recent studies have highlighted the importance of lymph node retrieval from disease staging and therapeutic standpoints. To define the role of lymph node dissection for ICC, this study aimed to evaluate the patterns of lymph node metastases and their prognostic implication. Methods: A retrospective cohort analysis was conducted for 56 consecutive patients who underwent R0/R1 resection for ICC between 1990 and 2015. In principle, lymph nodes in the hepatic hilum and around the pancreas head were systematically removed. For left-sided tumors, lymph nodes in the lesser curvature of the stomach and the root of left gastric artery were also dissected. Clinicopathologic predictors of 3-year survival were identified by Cox multivariate analyses. Lymph node mapping was performed and positive nodes were classified into 3 compartments based on metastatic rates and prognoses. Results: Median tumor size, 4.5 (1.5–16.0) cm; Mass-forming and its dominant type, 42 (75%); R0 resection, 47 (84%). Nineteen (34%) patients had lymph node metastases. After excluding 4 in-hospital deaths, the overall and recurrence-free survival rates at 3 years were 66% and 33%, respectively (median follow-up, 36 months). Cox multivariate analysis revealed lymph node metastases [hazard ratio (HR) 6.3, 95% confidence interval (CI) 1.9-21.7, P = 0.003] and R1 resection (HR 7.8, 95% CI 1.6-38.3, P = 0.01) as independent negative predictors of overall survival. Patients with ≥ 4 positive nodes ( n = 7) had significantly decreased survival compared with those with 1–3 positive nodes ( n = 10, P= 0.005). Metastatic lymph nodes were classified into compartments I (metastatic rates ≥ 10% and longest survival ≥ 3 years), II (5%–10% and 1-year survival ≥ 50%), and III ( < 5% and 1-year survival < 50%). Lymph nodes in the suprapyloric area, celiac trunk, and paraaorta belonged to compartment III and appeared less important to be dissected. Conclusions: Systematic lymph node dissection for ICC based on tumor location provides accurate staging and may prolong survival in patients with limited number of positive nodes. Compartment classification is useful to determine the extent of dissection.

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