Evaluation of prognostic factors and implication of lymph node dissection in intrahepatic cholangiocarcinoma: 10-year experience at a tertiary referral center

Miao-Erh Chang; Hao-Jan Lei; Ming-Huang Chen; Yi-Chen Yeh; Chung-Pin Li; Yi-Ping Hung; Cheng-Yuan Hsia; Chieu-An Liu; Gar-Yang Chau; Yee Chao

doi:10.1016/j.jcma.2016.09.010

Evaluation of prognostic factors and implication of lymph node dissection in intrahepatic cholangiocarcinoma: 10-year experience at a tertiary referral center

J Chin Med Assoc. 2017 Mar;80(3):140-146. doi: 10.1016/j.jcma.2016.09.010. Epub 2017 Feb 4.

Authors

Affiliations

¹ Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC.
² School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC. Electronic address: hjlei@vghtpe.gov.tw.
³ School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Department of Pathology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
⁴ School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
⁵ School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
⁶ School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.

PMID: 28169208
DOI: 10.1016/j.jcma.2016.09.010

Abstract

Background: Intrahepatic cholangiocarcinoma (ICC) is the second most common primary liver malignancy, and surgical resection remains the only potentially curative treatment. However, the existing literature indicates that those prognostic factors associated with outcome after surgery remain poorly defined.

Methods: Data were retrospectively collected from 103 patients with ICC who underwent surgical resection between 2005 and 2014. The patients were divided into two groups: one with (D1) and one without (D0) lymph node dissection of hepatic hilum according to the surgery performed. Thereafter, the prognostic values of clinicopathological characteristics were evaluated.

Results: The median overall survival (OS) after surgical resection of ICC was 43.9 months [95% confidence interval (CI), 11.6-76.2 months]. The 1-, 3-, and 5-year OS rates were 85.5%, 52.8%, and 45.6%, respectively. Multivariable analysis showed that lymph node metastases [hazard ratio (HR), 6.70; 95% CI, 2.18-20.55], positive resection margins (HR, 2.67; 95% CI, 1.14-6.23), periductal infiltration (HR, 3.64; 95% CI, 1.27-10.44), and poor differentiation (HR, 2.90; 95% CI, 1.41-5.95) were independently associated with poor survival. There were no significant differences in clinicopathological characteristics between D1 and D0 groups, except for vascular invasion (p = 0.018) and perineural invasion (p = 0.008). In the D1 group, lymph node metastases were associated with late T stages, multiple tumors, and elevated serum carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA19-9) levels.

Conclusion: Regional lymph node metastasis, positive resection margin, periductal infiltration, and poor differentiation were poor prognostic factors in patients with ICC after curative surgery. Lymph node dissection did not show survival benefits, but was useful for nodal staging. However, lymph node metastases were strongly associated with late T stages, multiple tumors, and elevated serum CEA and CA19-9 levels.

Keywords: cholangiocarcinoma; lymph node dissection; prognostic factors.

Publication types

Evaluation Study

MeSH terms

Adult
Aged
Bile Duct Neoplasms / mortality*
Bile Duct Neoplasms / surgery
Cholangiocarcinoma / mortality*
Cholangiocarcinoma / surgery
Female
Humans
Lymph Node Excision*
Male
Middle Aged
Prognosis
Referral and Consultation