Should Lymph Nodes Be Retrieved in Patients with Intrahepatic Cholangiocarcinoma? A Collaborative Korea–Japan Study
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1
Department of Surgery, Yonsei University College of Medicine, Seoul 03722, Korea
2
Department of Surgery, Seoul National University College of Medicine, Seoul 03080, Korea
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Department of Hepatobiliary and Pancreas Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea
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Center for Liver Cancer, National Cancer Center, Goyang 10408, Korea
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Department of Surgery, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu 42601, Korea
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Department of Surgery, Tohoku University Graduate School of Medicine, Sendai 980-8575, Japan
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Department of Surgery, Korea University College of Medicine, Seoul 02841, Korea
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Department of Surgery, College of Medicine Gyeongsang National University, Jinju 52727, Korea
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Department of Surgery, Iwate Medical University School of Medicine, Iwate 028-3694, Japan
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Department of Surgery, Hiroshima City Hiroshima Citizens Hospital, Hiroshima 730-8518, Japan
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Department of Surgery, Dong-A University College of Medicine, Busan 49201, Korea
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Department of Surgery, Jeonbuk National University Medical School, Jeonju 54907, Korea
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Department of Surgery, Kobe University Graduate School of Medicine, Kobe 657-850, Japan
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Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Yokohama 326-0027, Japan
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Department of Surgery, Hyogo College of Medicine, Nishinomiya 663-8501, Japan
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Department of General Surgery, Kurashiki Central Hospital, Kurashiki 710-8602, Japan
17
Department of Surgery, Pusan National University College of Medicine, Busan 49241, Korea
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Department of Gastroenterological Surgery, Kochi Health Sciences Center, Kochi 781-8555, Japan
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Department of Surgery, Nagasaki Medical Center, Nagasaki 856-0835, Japan
20
Department of Surgery, Kansai Medical University, Osaka 573-1191, Japan
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Department of Gastroenterological, Breast and Endocrine Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi 753-8511, Japan
22
Department of Surgery, Dongguk University College of Medicine, Goyang 10326, Korea
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Department of Surgery, Otsu Red Cross Hospital, Otsu 520-0046, Japan
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Department of Hepato-Biliary-Pancreatic Surgery, Graduate School of Medicine, Osaka City University, Osaka 558-0022, Japan
25
Department of Surgery, Sungkyunkwan University School of Medicine, Seoul 16419, Korea
*
Authors to whom correspondence should be addressed.
†
Contributed equally as co-corresponding author.
Cancers 2021, 13(3), 445; https://doi.org/10.3390/cancers13030445
Received: 2 December 2020
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Revised: 8 January 2021
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Accepted: 14 January 2021
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Published: 25 January 2021
(This article belongs to the Section Cancer Therapy)
Simple Summary
Intrahepatic cholangiocarcinoma (IHCC) is the second most common primary hepatic malignant tumor after hepatocellular carcinoma (HCC). The prevalence of lymph node metastases (LNM) detected at surgery for IHCC has been reported as 25–50%, and lymph node metastasis is known to be significantly associated with poor survival outcomes. However, the oncologic value of lymph node dissection in resected IHCC is still controversial. According to the present Korea–Japan international collaborative study, it was found that surgical retrieval of more than four lymph nodes (≥4 LNs) could improve survival outcome in resected IHCC with LNM. Based on preoperatively detectable parameters, a nomogram was established to predict LNM to suggest tailored intraoperative LN management in patients with IHCC. Further prospective research is needed to validate the present surgical strategy in resected IHCC.
Background: This study was performed to investigate the oncologic role of lymph node (LN) management and to propose a surgical strategy for treating intrahepatic cholangiocarcinoma (IHCC). Methods: The medical records of patients with resected IHCC were retrospectively reviewed from multiple institutions in Korea and Japan. Short-term and long-term oncologic outcomes were analyzed according to lymph node metastasis (LNM). A nomogram to predict LNM in treating IHCC was established to propose a surgical strategy for managing IHCC. Results: A total of 1138 patients were enrolled. Of these, 413 patients underwent LN management and 725 did not. A total of 293 patients were found to have LNM. The No. 12 lymph node (36%) was the most frequent metastatic node, and the No. 8 lymph node (21%) was the second most common. LNM showed adverse long-term oncologic impact in patients with resected IHCC (14 months, 95% CI (11.4–16.6) vs. 74 months, 95% CI (57.2–90.8), p < 0.001), and the number of LNM (0, 1–3, 4≤) was also significantly related to negative oncologic impacts in patients with resected IHCC (74 months, 95% CI (57.2–90.8) vs. 19 months, 95% CI (14.4–23.6) vs. 11 months, 95% CI (8.1–13.8)), p < 0.001). Surgical retrieval of more than four (≥4) LNs could improve the survival outcome in resected IHCC with LNM (13 months, 95% CI (10.4–15.6)) vs. 30 months, 95% CI (13.1–46.9), p = 0.045). Based on preoperatively detectable parameters, a nomogram was established to predict LNM according to the tumor location. The AUC was 0.748 (95% CI: 0.706–0.788), and the Hosmer and Lemeshow goodness of fit test showed p = 0.4904. Conclusion: Case-specific surgical retrieval of more than four LNs is required in patients highly suspected to have LNM, based on a preoperative detectable parameter-based nomogram. Further prospective research is needed to validate the present surgical strategy in resected IHCC.
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Keywords:
cholangiocarcinoma; lymph nodes; metastasis; nomograms
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MDPI and ACS Style
Kang, C.M.; Suh, K.-S.; Yi, N.-J.; Hong, T.H.; Park, S.J.; Ahn, K.S.; Hayashi, H.; Choi, S.B.; Jeong, C.-Y.; Takahara, T.; Shiozaki, S.; Roh, Y.H.; Yu, H.C.; Fukumoto, T.; Matsuyama, R.; Naoki, U.; Hashida, K.; Seo, H.I.; Okabayashi, T.; Kitajima, T.; SATOI, S.; Nagano, H.; Kim, H.; Taira, K.; Kubo, S.; Choi, D.W. Should Lymph Nodes Be Retrieved in Patients with Intrahepatic Cholangiocarcinoma? A Collaborative Korea–Japan Study. Cancers 2021, 13, 445. https://doi.org/10.3390/cancers13030445
AMA Style
Kang CM, Suh K-S, Yi N-J, Hong TH, Park SJ, Ahn KS, Hayashi H, Choi SB, Jeong C-Y, Takahara T, Shiozaki S, Roh YH, Yu HC, Fukumoto T, Matsuyama R, Naoki U, Hashida K, Seo HI, Okabayashi T, Kitajima T, SATOI S, Nagano H, Kim H, Taira K, Kubo S, Choi DW. Should Lymph Nodes Be Retrieved in Patients with Intrahepatic Cholangiocarcinoma? A Collaborative Korea–Japan Study. Cancers. 2021; 13(3):445. https://doi.org/10.3390/cancers13030445
Chicago/Turabian StyleKang, Chang M., Kyung-Suk Suh, Nam-Joon Yi, Tae H. Hong, Sang J. Park, Keun S. Ahn, Hiroki Hayashi, Sae B. Choi, Chi-Young Jeong, Takeshi Takahara, Shigehiro Shiozaki, Young H. Roh, Hee C. Yu, Takumi Fukumoto, Ryusei Matsuyama, Uyama Naoki, Kazuki Hashida, Hyung I. Seo, Takehiro Okabayashi, Tomoo Kitajima, Sohei SATOI, Hiroaki Nagano, Hongbeom Kim, Kaoru Taira, Shoji Kubo, and Dong W. Choi. 2021. "Should Lymph Nodes Be Retrieved in Patients with Intrahepatic Cholangiocarcinoma? A Collaborative Korea–Japan Study" Cancers 13, no. 3: 445. https://doi.org/10.3390/cancers13030445
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