Adequate lymph node dissection is essential for accurate nodal staging in intrahepatic cholangiocarcinoma: A population-based study

作者全名："Zhu, Jiang; Liu, Chang; Li, Hui; Ren, Haoyu; Cai, Yunshi; Lan, Tian; Wu, Hong"

作者地址："[Zhu, Jiang; Cai, Yunshi; Lan, Tian; Wu, Hong] Sichuan Univ, West China Hosp, Liver Transplantat Ctr, 37 Guoxue Lane, Chengdu 610041, Peoples R China; [Liu, Chang] Sichuan Univ, West China Hosp, Dept Liver Surg, Chengdu, Peoples R China; [Liu, Chang] Chengdu ShangJin NanFu Hosp, Dept Hepatopancreatobiliary Minimal Invas Surg, Chengdu, Peoples R China; [Li, Hui] Chongqing Univ Canc Hosp, Dept Hepatobiliary Pancreat Tumor Ctr, Chongqing Key Lab Translat Res Canc Metastasis & I, Chongqing, Peoples R China; [Ren, Haoyu] Chongqing Med Univ, Dept Breast & Thyroid Surg, Affiliated Hosp 2, Chongqing, Peoples R China; [Ren, Haoyu] Ludwig Maximilians Univ Munchen, Univ Hosp, Dept Gen Visceral & Transplantat Surg, Munich, Germany"

通信作者："Lan, T; Wu, H (通讯作者)，Sichuan Univ, West China Hosp, Liver Transplantat Ctr, 37 Guoxue Lane, Chengdu 610041, Peoples R China."

来源：CANCER MEDICINE

ESI学科分类：CLINICAL MEDICINE

WOS号：WOS:000913062400001

JCR分区：Q2

影响因子：2.9

年份：2023

卷号：12

期号：7

开始页：8184

结束页：8198

文献类型：Article

关键词：intrahepatic cholangiocarcinoma; lymph node dissection; nodal stage; number of lymph node metastasis; prognosis

摘要："PurposeTo comprehensively investigate the implications of lymph node dissection (LND) and the prognostic impact of the number of lymph node (LN) metastases on survival in intrahepatic cholangiocarcinoma (ICC) using a large-scale study. MethodsPatients who underwent surgical resection for ICC between 2004 and 2018 were identified from the Surveillance, Epidemiology, and End Results (SEER) registries. The Kaplan-Meier and log-rank tests were used to compare cancer-specific survival (CSS) and overall survival (OS) between different groups. Propensity score matching (PSM) and subgroup analyses were performed to balance potential confounding factors. A multivariate Cox proportional hazards regression model was used to identify prognostic factors of survival outcomes. Restricted cubic splines fitted in the Cox proportional hazard regression models were also conducted to examine associations between continuous variables and outcomes. ResultsIn all, 1028 patients were enrolled. There were 652 (63.4%) patients undergoing LND, with lymph node metastasis (LNM) confirmed in 212 (32.5%) cases. Patients receiving LND did not show better survival outcomes than those receiving non-LND (NLND). We divided the LND group into two subgroups: patients with LNM (+) and those without LNM (-). Among these three groups, patients with LNM experienced the worst CSS and OS, while NLND patients had similar survival times to LNM (-) patients. Restricted cubic spline analysis indicated that an increased number of LNM was associated with a decreased chance of survival (p < 0.001). Patients who received LND were further categorized as having no nodal metastasis (N0), 1-2 LNM (N1), or >= 3 LNM (N2) according to the number of LNM. The Kaplan-Meier curves showed that the mortality risk of patients with N0, N1, and N2 disease (median CSS, N0 50.0 vs. N1 22.0 vs. N2 14.0 months; median OS, N0 46.0 vs. N1 21.0 vs. N2 14.0 months, all p < 0.01) increased significantly, except for patients who had <6 LNs harvested. On multivariable survival analysis, a higher nodal stage (N1 vs. N0: CSS, hazard ratio [HR] 2.135, 95% CI 1.636-2.788, p < 0.001; OS, HR 2.100, 95% CI 1.624-2.717, p < 0.001; N2 vs. N0: CSS, HR 4.027, 95% CI 2.791-5.811, p < 0.001; OS, HR 3.678, 95% CI 2.561-5.282, p < 0.001) was an independent prognostic risk factor for survival. ConclusionsDespite the lack of a clear survival benefit of LND in patients with ICC, a significant positive association between the number of LNM and poor outcomes was observed. We still suggest adequate LND by examining at least six LNs to ensure precise staging. On this basis, the recently proposed nodal classification of N0, N1, and N2 stages may also allow better prognostic stratification of ICC patients."

基金机构：　

基金资助正文：