BACKGROUND Clinically lymph node positive (cLNP) intrahepatic cholangiocarcinoma (ICC) carries a poor prognosis, without clear management guidelines for the practicing clinician. We sought to evaluate current practice patterns for cLNP ICC, including associations with survival. METHODS The National Cancer Database was queried for patients with cLNP ICC, without extrahepatic metastases. RESULTS We identified 1023 patients with cLNP ICC, 77%% (n = 784) of whom received chemotherapy alone. Resection was undertaken in 23% (n = 239) of patients and was most commonly utilized in combination with chemotherapy (n = 150). Median survival for all patients was 13.6 months. Patients undergoing resection in combination with chemotherapy were associated with an improved survival (22.5 months) as compared to those patients receiving chemotherapy alone (11.9 months) or resection alone (12.4 months) (p < 0.01). Finally, we compared the survival of patients with cLNP ICC with that of patients with pathologically proved lymph node positive (pLNP) ICC, all of whom were treated with resection with chemotherapy, and found no difference in survival (22.5 months-19.3 months, p = 0.99, respectively). CONCLUSIONS While the decision to pursue resection for ICC is multifactorial and patient specific, the presence of clinically positive LNs should not represent a contraindication.

中文翻译：

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切除和化疗是临床淋巴结阳性肝内胆管癌患者的最佳治疗方法。

背景临床淋巴结阳性 (cLNP) 肝内胆管癌 (ICC) 预后不良，临床医生没有明确的管理指南。我们试图评估 cLNP ICC 的当前实践模式，包括与生存的关联。方法 查询国家癌症数据库中无肝外转移的 cLNP ICC 患者。结果 我们确定了 1023 名 cLNP ICC 患者，其中 77%% (n = 784) 接受了单独的化疗。23% (n = 239) 的患者进行了切除，最常与化疗联合使用 (n = 150)。所有患者的中位生存期为 13.6 个月。与单独接受化疗的患者相比，接受切除联合化疗的患者生存率提高（22.5 个月）（11. 9 个月）或单独切除（12.4 个月）（p < 0.01）。最后，我们比较了 cLNP ICC 患者与病理证实淋巴结阳性 (pLNP) ICC 患者的生存率，他们都接受了化疗切除术，发现生存率没有差异（22.5 个月-19.3 个月，p = 0.99，分别）。结论 虽然对 ICC 进行切除术的决定是多因素和患者特异性的，但临床阳性 LN 的存在不应代表禁忌症。分别）。结论 虽然对 ICC 进行切除术的决定是多因素和患者特异性的，但临床阳性 LN 的存在不应代表禁忌症。分别）。结论 虽然对 ICC 进行切除术的决定是多因素和患者特异性的，但临床阳性 LN 的存在不应代表禁忌症。