Clinical implication of tumor site in terms of node metastasis for intrahepatic cholangiocarcinoma.

Abstract

BACKGROUND:

The clinical implication of lymph node (LN) dissection of intrahepatic cholangiocarcinoma (ICCA) is still controversial, and LN metastasis (LNM) based on tumor site has not been confirmed yet.

METHODS:

Patients who underwent curative-intent surgery at 10 tertiary referral centers were identified and divided into peripheral (PP) and near second confluence level tumor (NC) groups on the basis of the distance from the second confluence and oncological outcomes were compared.

RESULTS:

Of 179 patients, 121 patients with LND were divided into the NC (n = 89) and PP groups (n = 32) on the basis of 4.5 cm from the second confluence. NC group showed higher LNM rate than PP group (46.1 vs 21.9%, p = 0.016) and NC was a risk factor for LNM (odds ratio: 4.367; 95% confidence interval: 1.234-15.453, p = 0.022). The 5-year overall survival (OS) rate (38.0% vs. 27.8%, p = 0.777) and recurrence-free survival (RFS) rates (22.8% vs. 25.8%, p = 0.742) showed no differences between the PP and NC groups. In the NC group, N1 patients showed worse 5-year OS (12.7% vs 39.0%, p = 0.004) and RFS (8.8% vs 28.6%, p = 0.004) than the N0 patients. In the PP group, discordant results in 5-year OS (48.9% vs. 50.0%, p = 0.462) and RFS (41.3% vs. 0%, p = 0.056) were found between the N0 and N1 patients.

CONCLUSION:

The NC group was an independent risk factor for LNM and LNM worsened prognosis in NC group for ICCA. In the PP group, LND should not be omitted because of high LNM rate and insufficient oncologic evidence.

• Authors: Woohyung Lee, Chi-Young Jeong, Jae Yool Jang, Young Hoon Roh, Kwan Woo Kim, Sung Hwa Kang, Myung Hee Yoon, Hyung Il Seo, Jeong-Ik Park, Bo-Hyun Jung, Dong Hoon Shin, Young Il Choi, Hyung Hwan Moon, Je Ho Ryu, Kwangho Yang, Chang Soo Choi, Yo-Han Park, Yang Won Nah, Ryounggo Kim, Jonathan Navarro, Dae-Hoon Han, Gi Hong Choi, Chang Moo Kang, Kyung-Sik Kim, Soon-Chan Hong
• Journal: European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology (Eur J Surg Oncol) Vol. 46 Issue 5 Pg. 832-838 (05 2020) ISSN: 1532-2157 [Electronic] England
• PMID: 31806519 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2019 The Authors. Published by Elsevier Ltd.. All rights reserved.

Topics

• Aged
• Anastomosis, Surgical
• Bile Duct Neoplasms (pathology, surgery)
• Bile Ducts, Intrahepatic
• Cholangiocarcinoma (pathology, surgery)
• Disease-Free Survival
• Female
• Hepatectomy
• Humans
• Jejunum (surgery)
• Kaplan-Meier Estimate
• Klatskin Tumor (pathology, surgery)
• Liver (surgery)
• Lymph Node Excision
• Lymph Nodes (pathology)
• Lymphatic Metastasis
• Male
• Middle Aged
• Neoplasm Grading
• Neoplasm Staging
• Proportional Hazards Models