Should Lymph Nodes Be Retrieved in Patients with Intrahepatic Cholangiocarcinoma? A Collaborative Korea-Japan Study.
Should Lymph Nodes Be Retrieved in Patients with Intrahepatic Cholangiocarcinoma? A Collaborative Korea-Japan Study.
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DOI：
10.3390/cancers13030445
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发表时间：
2021-01-25
期刊：
影响因子：
5.2
通讯作者：
Choi DW
中科院分区：
文献类型：
--
作者：
Kang CM;Suh KS;Yi NJ;Hong TH;Park SJ;Ahn KS;Hayashi H;Choi SB;Jeong CY;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
肝内胆管癌（IHCC）是仅次于肝细胞癌（HCC）的第二常见的原发性肝脏恶性肿瘤。据报道，IHCC手术中发现的淋巴结转移（LNM）的发生率为25-50%，并且已知淋巴结转移与较差的生存结果显著相关。然而，淋巴结清扫在IHCC切除术中的肿瘤学价值仍存在争议。根据目前韩国和日本的国际合作研究，发现手术切除4个以上淋巴结（≥4个淋巴结）可以改善切除的IHCC合并LNM的生存结果。基于术前可检测的参数，建立了一个nomogram来预测LNM，从而为IHCC患者的术中LN管理提供建议。需要进一步的前瞻性研究来验证目前切除的IHCC的手术策略。背景：本研究旨在探讨淋巴结（LN）管理的肿瘤学作用，并提出治疗肝内胆管癌（IHCC）的手术策略。方法：回顾性分析韩国和日本多家机构IHCC切除术患者的医疗记录。根据淋巴结转移（LNM）情况分析近期和远期肿瘤预后。建立了预测LNM治疗IHCC的nomogram，以提出治疗IHCC的手术策略。结果：共入组1138例患者。其中，413例患者接受了LN治疗，725例未接受治疗。293例患者被发现有LNM。12号淋巴结（36%）是最常见的转移淋巴结，8号淋巴结（21%）是第二常见的转移淋巴结。LNM在切除的IHCC患者中显示出不良的长期肿瘤影响(14个月，95% CI (11.4-16.6) vs. 74个月，95% CI (57.2-90.8), p < 0.001)， LNM的数量（0,1 - 3,4≤）也与切除的IHCC患者的负面肿瘤影响显著相关(74个月，95% CI （57.2-90.8) vs. 19个月，95% CI (14.4-23.6) vs. 11个月，95% CI (8.1-13.8)), p < 0.001）。手术切除4个以上（≥4）个LNs可以改善切除的IHCC合并LNM的生存结果（13个月，95% CI （10.4-15.6)） vs. 30个月，95% CI (13.1-46.9), p = 0.045）。基于术前可检测的参数，根据肿瘤的位置，建立一个nomogram来预测LNM。AUC为0.748 (95% CI: 0.706 ~ 0.788)， Hosmer和Lemeshow拟合优度检验p = 0.4904。结论：根据术前可检测到的参数图，高度怀疑患有LNM的患者需要进行超过4个ln的手术切除。需要进一步的前瞻性研究来验证目前切除的IHCC的手术策略。
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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