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. 2021 Mar 11:11:585808.
doi: 10.3389/fonc.2021.585808. eCollection 2021.

Prognostic Value of Lymph Node Dissection for Intrahepatic Cholangiocarcinoma Patients With Clinically Negative Lymph Node Metastasis: A Multi-Center Study From China

Qiao Ke  1 , Lei Wang  2 , Ziguo Lin  1 , Jianying Lou  3 , Shuguo Zheng  4 , Xinyu Bi  5 , Jianming Wang  6 , Wei Guo  7 , Fuyu Li  8 , Jian Wang  9 , Yamin Zheng  10 , Jingdong Li  11 , Shi Cheng  12 , Weiping Zhou  13 , Yongyi Zeng  1
Affiliations

Prognostic Value of Lymph Node Dissection for Intrahepatic Cholangiocarcinoma Patients With Clinically Negative Lymph Node Metastasis: A Multi-Center Study From China

Qiao Ke et al. Front Oncol. .

Abstract

Background: The clinical value of lymph-node dissection (LND) for intrahepatic carcinoma (ICC) patients with clinically negative lymph node metastasis (LNM) remains unclear; hence we conducted a multi-center study to explore it.

Methods: Patients who were diagnosed ICC with clinically negative LNM and underwent hepatectomy with or without LND from December 2012 to December 2015 were retrospectively collected from 12 hepatobiliary centers in China. Overall survival (OS) was analyzed using the Kaplan-Meier method, and then subgroup analysis was conducted stratified by variables related to the prognosis.

Results: A total of 380 patients were eligible including 106 (27.9%) in the LND group and 274 (72.1%) in the non-LND group. Median OS in the LND group was slightly longer than that in the non-LND group (24.0 vs. 18.0 months, P = 0.30), but a significant difference was observed between the two groups (24.0 vs. 14.0 months, P = 0.02) after a well-designed 1:1 propensity score matching without increased severe complications. And, LND was identified to be one of the independent risk factors of OS (HR = 0.66, 95%CI = 0.46-0.95, P = 0.025). Subgroup analysis in the matched cohort showed that patients could benefit more from LND if they were male, age <60 years, had no HBV infection, with ECOG score <2, CEA ≤5 ug/L, blood loss ≤400 ml, transfusion, major hepatectomy, resection margin ≥1 cm, tumor size >5 cm, single tumor, mass-forming, no satellite, no MVI, and no perineural invasion (all P < 0.05). Furthermore, only patients with pathologically confirmed positive LNM were found to benefit from postoperative adjuvant therapy (P < 0.001).

Conclusion: With the current data, we concluded that LND would benefit the selected ICC patients with clinically negative LNM and might guide the postoperative management.

Keywords: intrahepatic cholangiocarcinoma; lymph node dissection; node-negative; overall survival; propensity score matching.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The reviewer JL declared a shared affiliation, with no collaboration, with several of the authors QK, LW, ZL, YZ to the handling editor at the time of the review.

Figures

Figure 1
Figure 1
Flow chart of patients’ enrollment. ICC, intrahepatic carcinoma; LND, lymph node dissection.
Figure 2
Figure 2
Overall survival of patients receiving lymph node dissection (LND) or not before (A) and after propensity score matching (B).
Figure 3
Figure 3
Forest plot of subgroup analysis stratified by risk factors in the matched cohort.
Figure 4
Figure 4
(A) Overall survival (OS) of patients with hepatectomy alone (non-LND), lymph node metastasis (p-LNM+), and no lymph node metastasis (p-LNM−). (B–D) OS of patients with p-LNM+, p-LNM−, and non-LND receiving postoperative adjuvant treatment or not.
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