HPB ( IF 2.7 ) Pub Date : 2020-02-08 , DOI: 10.1016/j.hpb.2020.01.009 Jonathan G Navarro 1 , Jin Ho Lee 2 , Incheon Kang 3 , Seoung Yoon Rho 3 , Gi Hong Choi 3 , Dai Hoon Han 3 , Kyung Sik Kim 3 , Jin Sub Choi 3
Background
Lymph node (LN) metastasis portends a worse prognosis following resection of intrahepatic cholangiocarcinoma (ICC); however, lymphadenectomy is not routinely performed, as its role remains controversial. Herein, we developed a risk model for LN metastasis by identifying its predictive factors and assessed a subset of patients who might not benefit from LN dissection (LND).
Methods
210 patients who underwent curative-intent surgery for ICC were retrospectively reviewed. A preoperative risk model for LN metastasis was developed following identification of its preoperative predictive factors using the recursive partitioning method.
Results
In the multivariable analysis, CA 19-9 level of >120 U/mL, an enlarged LN on computed tomography, and a tumor location abutting the Glissonean pedicles were independent predictors of LN metastasis. The preoperative risk model classified the patients according to their risk: high, intermediate, and low risks at a rate of LN metastasis on final pathology of 60.9%, 35%, and 2.3%, respectively. In the subgroup analysis among the low-risk patients, performance of LND had no survival advantage over non-performance of LND.
Conclusion
Routine LND for preoperatively diagnosed ICC should be recommended to patients at an intermediate and a high risk of developing LN metastasis but may be omitted for low-risk patients.
中文翻译:
可切除肝内胆管癌淋巴结转移的预后意义和风险预测模型:都需要淋巴结清扫吗?
背景
淋巴结(LN)转移预示着肝内胆管癌(ICC)切除后预后较差;然而,淋巴结切除术并不常规进行,因为它的作用仍然存在争议。在此,我们通过确定其预测因素开发了 LN 转移的风险模型,并评估了可能无法从 LN 剥离 (LND) 中受益的一部分患者。
方法
回顾性分析了 210 名因 ICC 接受根治性手术的患者。在使用递归分区方法识别其术前预测因素后,开发了 LN 转移的术前风险模型。
结果
在多变量分析中,CA 19-9 水平 > 120 U/mL、计算机断层扫描上扩大的 LN 和毗邻 Glissonean 椎弓根的肿瘤位置是 LN 转移的独立预测因子。术前风险模型根据患者的风险对患者进行分类:高风险、中风险和低风险,最终病理学上的 LN 转移率分别为 60.9%、35% 和 2.3%。在低风险患者的亚组分析中,进行 LND 与未进行 LND 相比,没有生存优势。
结论
术前诊断为 ICC 的常规 LND 应推荐给发生 LN 转移的中高风险患者,但对于低风险患者可以省略。