Should Lymph Nodes Be Retrieved in Patients with Intrahepatic Cholangiocarcinoma? A Collaborative Korea–Japan Study
Abstract
:Simple Summary
Abstract
1. Introduction
2. Results
2.1. General Characteristics of Patients and Primary Tumors
2.2. Distribution of Metastatic Lymph Nodes in Patients with Resected IHCC
2.3. Oncologic Impact of Metastatic Lymph Nodes in Patients with Resected IHCC
2.4. Oncologic Impact of Number of Retrieved Lymph Nodes on N0, and N1 Patients with Resected IHCC
2.5. Can Lymph Node Metastasis Be Preoperatively Predicted in Patients with Resected IHCC? Developing a Surgeon-Oriented Nomogram to Predict Lymph Node Metastasis
2.6. Indirect External Validation of Nomogram in Nx Patients with Resected IHCC
2.7. Proposed Surgical Strategy in Lymph Node Management for IHCC
3. Discussion
4. Materials and Methods
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Patients (N = 1138) | |
---|---|
Sex | |
Male | 758 (66.6%) |
Female | 380 (33.4%) |
Age (years) | 63.4 ± 9.8 |
Previous symptoms | |
Yes | 535 (47.0%) |
No | 603 (53.0%) |
American Sosciety of Anesthesiologists (ASA) score | |
1 | 250 (24.6%) |
2 | 662 (65.2%) |
3 | 98 (9.6%) |
4 | 1 (0.1%) |
5 | 1 (0.1%) |
Karnofsky scale | |
50 | 1 (0.1%) |
60 | 5 (0.5%) |
70 | 25 (2.6%) |
80 | 142 (14.8%) |
90 | 518 (54.1%) |
100 | 267 (27.9%) |
Tumor location side | |
Right liver | 558 (50.4%) |
Left liver | 549 (49.6%) |
Operation name | |
Lt. lateral sectionectomy | 75 (6.6%) |
Lt hemihepatectomy | 325 (28.6%) |
Lt extended hepatectomy | 126 (11.1%) |
Rt hemihepatectomy | 295 (25.9%) |
Rt extended hepatectomy | 79 (6.9%) |
Trisectionectomy | 31 (2.7%) |
Bisegmentectomy | 65 (5.7%) |
Segmentectomy | 142 (12.5%) |
Lymph node retrieval | |
No | 413 (36.3%) |
Yes | 725 (63.7%) |
Serum Carcinoembryonic antigen (CEA) (ng/mL) | 21.5 ± 111.3 |
Serum 19-9 (U/mL) | 2273.9 ± 10,816.4 |
Tumor Side | Right-Sided (N = 112) | Left-Sided (N = 181) | p |
---|---|---|---|
No. 7 Lymph node (LN) | 0.013 | ||
No | 109 (97.3%) | 162 (89.5%) | |
Metastasis | 3 (2.7%) | 19 (10.5%) | |
No. 12 LN | 0.065 | ||
No | 47 (42.0%) | 96 (53.0%) | |
Metastasis | 65 (58.0%) | 85 (47.0%) | |
No. 13 LN | 0.024 | ||
No | 93 (83.0%) | 166 (91.7%) | |
Metastasis | 19 (17.0%) | 15 (8.3%) | |
Perigastric LN | 0.052 | ||
No | 109 (97.3%) | 166 (91.7%) | |
Metastasis | 3 (2.7%) | 15 (8.3%) |
Variable | Univariate | Multivariate | ||
---|---|---|---|---|
OR (95% CI) | p-Value | OR (95% CI) | p-Value | |
Sex (Male/Female) | 1.08 (0.798–1.463) | 0.6164 | ||
Age, years | 0.989 (0.974–1.004) | 0.1401 | 0.991 (0.974–1.009) | 0.3427 |
Chief complaint (no/yes) | 1.81 (1.344–2.438) | 0.0001 | 1.803 (1.245–2.612) | 0.0018 |
ASA | 0.727 (0.505–1.046) | 0.0854 | ||
0.873 (0.479–1.591) | 0.6575 | |||
Karnofsky score | 0.995 (0.975–1.016) | 0.657 | ||
Radiologic tumor size, cm | 1.092 (1.033–1.156) | 0.0021 | 1.055 (0.982–1.134) | 0.1415 |
Gross type | 0.917 (0.748–1.124) | 0.4023 | ||
Tumor location (Right/Left) | 1.546 (1.148–2.082) | 0.0042 | ||
Number of the tumor | 1.303 (0.985–1.723) | 0.064 | ||
Left hemihepatectomy | 1.122 (0.555–2.268) | 0.7495 | 1.646 (0.685–3.952) | 0.2649 |
Left extended hemihepatectomy | 1.608 (0.755–3.425) | 0.2185 | 2.713 (1.079–6.825) | 0.0339 |
Right hemihepatectomy | 0.651 (0.315–1.343) | 0.2448 | 0.777 (0.319–1.896) | 0.5799 |
Right extended hemihepatectomy | 1.004 (0.44–2.288) | 0.9934 | 1.39 (0.515–3.752) | 0.5156 |
Trisectionentectomy | 2.514 (0.804–7.862) | 0.1129 | 3.488 (0.925–13.15) | 0.0651 |
Bisegmentectomy | 0.933 (0.365–2.384) | 0.8854 | 1.301 (0.411–4.117) | 0.6539 |
Segmentectomy | 0.304 (0.121–0.766) | 0.0116 | 0.694 (0.233–2.066) | 0.5119 |
Preoperative CEA | 2.113 (1.537–2.903) | <0.0001 | 1.966 (1.352–2.857) | 0.0004 |
Preoperative CA 19-9 | 3.389 (2.475–4.643) | <0.0001 | 2.648 (1.837–3.819) | <0.0001 |
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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.; et al. 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
Kang CM, Suh K-S, Yi N-J, Hong TH, Park SJ, Ahn KS, Hayashi H, Choi SB, Jeong C-Y, Takahara T, et al. 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 Moo, Kyung-Suk Suh, Nam-Joon Yi, Tae Ho Hong, Sang Jae Park, Keun Soo Ahn, Hiroki Hayashi, Sae Byeol Choi, Chi-Young Jeong, Takeshi Takahara, and et al. 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