title: Number of lymph node metastases is a significant prognostic factor in intrahepatic cholangiocarcinoma.
abstract: Intrahepatic cholangiocarcinoma (IHCC) is a rare primary hepatic tumor. Outcomes after resection and the use of lymph node dissection have not been well described. From a prospective database, we identified 53 patients with IHCC who underwent exploration between April 1983 and March 2004. Hepatic resection was performed in 44 patients, 30 of whom underwent lymph node dissection. Clinicopathological features and outcomes were analyzed. The actuarial 1-year survival was 66.2% in resected patients, compared to 0% in unresectable patients (p < 0.0001), with a 50% overall survival of 21.5 months and 3.1 months, respectively. The actuarial 3-year and 5-year overall survival rates in resected patients were 38.3% and 26.3%, respectively. Univariate analysis revealed that factors associated with poor overall survival included multiple tumors, extrahepatic bile duct involvement, noncurative resection, and involvement of lymph nodes. Multivariate analysis in resected patients revealed that multiple tumors (p < 0.0074) and non-curative resection (p = 0.0068) were significant risk factors for poor overall survival. The survival rate in patients with three or more positive nodes was significantly lower than in those with fewer than three (p < 0.0001). Three patients with solitary tumors and one or two involved lymph nodes have survived beyond 4 years after extended lobectomy with systemic lymphadenectomy. Curative resection, single tumor, and fewer than two lymph node metastases were prognostic factors for good outcome. Curative resection with lymph node dissection improved survival in patients with no more than two positive lymph nodes.
authors.affiliation: Department of General Surgery, Hokkaido University, Graduate School of Medicine, N15W7, Kita-ku, Sapporo, Japan.
authors.forename: Takahito
authors.initials: T
authors.lastname: Nakagawa
authors.forename: Toshiya
authors.initials: T
authors.lastname: Kamiyama
authors.forename: Nobuaki
authors.initials: N
authors.lastname: Kurauchi
authors.forename: Michiaki
authors.initials: M
authors.lastname: Matsushita
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Nakanishi
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Kamachi
authors.forename: Takeaki
authors.initials: T
authors.lastname: Kudo
authors.forename: Satoru
authors.initials: S
authors.lastname: Todo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000401:mortality* / Q000473:pathology* / Q000601:surgery; D001653:Bile Ducts, Intrahepatic; D018281:Cholangiocarcinoma / Q000401:mortality* / Q000556:secondary* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome