Is Lymphadenectomy Reasonable for Elderly Intrahepatic Cholangiocarcinoma Patients?

Abstract

Background: In this study, we aimed to determine the impact of lymphadenectomy (LND) on clinical outcomes in ICC patients aged ≥ 70 years.

Methods: Four hundred and three eligible patients diagnosed with ICC who underwent hepatectomy between 2004 and 2019 were enrolled in the Surveillance, Epidemiology, and End Results database. The impact of LND on perioperative mortality and overall survival (OS) as well as the optimal total number of lymph nodes examined (TNLE) was estimated.

Results: One hundred thirty-nine pairs of patients were matched by propensity score matching. Perioperative mortality was comparable between the LND and non-LND (nLND) groups (0.7% vs. 2.9%, P = 0.367). The median OS in the LND group was significantly longer (44 vs. 32 months, P = 0.045) and LND was identified as an independent protective factor for OS by multivariate analysis (HR 0.65, 95% CI 0.46-0.92, P = 0.014). Patients with the following characteristics were potential beneficiaries of LND: white, female, no/moderate fibrosis, tumor size > 5 cm, solitary tumor, and localized invasion (all P < 0.05). TNLE ≥ 6 had the greatest discriminatory power for identifying lymph node metastasis (area under the curve, 0.704, Youden index, 0.365, P = 0.002). Patients with pathologically confirmed lymph node metastasis are likely to benefit from adjuvant therapy (40 months vs. 4 months, P = 0.052).

Conclusions: Advanced age (≥ 70 years) was not a contraindication for LND, which facilitates accurate nodal staging and guides postoperative management. Appropriately selected elderly populations could benefit from LND.

Keywords: Elderly; Intrahepatic cholangiocarcinoma; Lymphadenectomy; Overall survival; Perioperative mortality.

Fig. 1

Flow chart of patient enrollment. One patient died perioperatively in the adequate-lymphadenectomy (AD-LND) group, which was excluded from the survival analysis

Fig. 2

Receiver operative characteristics (ROC) analysis of identifying the optimal total number of lymph nodes examined (TNLE) for detecting LNM

Fig. 3

Overall survival of patients receiving lymphadenectomy (LND) or not before (A) and after propensity score matching (B)

Fig. 4

Forest plot of subgroup analysis stratified by risk factors in the matched cohort. nLND, non-lymphadenectomy; LND, lymphadenectomy

Fig. 5

Overall survival of patients with negative, positive, or unstaged nodal status

Fig. 6

Overall survival of patients who received postoperative chemotherapy (A–C) or radiotherapy according to nodal status (D–F)