title: Prognostic Impact of Preoperative Lymph Node Enlargement in Intrahepatic Cholangiocarcinoma: A Multi-Institutional Study by the Kyushu Study Group of Liver Surgery.
abstract: BACKGROUND
  Although lymph node metastasis (LNM) has been considered an important prognostic factor for intrahepatic cholangiocarcinoma (ICC), the impact of lymph node enlargement on the prognosis of ICC, and the accuracy of diagnosis of LNM, have not been fully clarified.
  
  
  METHODS
  Using a chart review of 225 patients with ICC, we compared survival times between patients with and without lymph node enlargement, and we evaluated the accuracy of diagnosis of LNM. We also performed a multivariate analysis to determine the variables affecting overall survival in the study population.
  
  
  RESULTS
  The survival time of patients without lymph node enlargement was significantly longer than that of patients with lymph node enlargement (median survival time [MST] 43.7 vs. 20.1 months; p = 0.007). However, in the group with enlarged lymph nodes, survival time was prolonged as a result of hepatectomy (MST 20.1 vs. 7.6 months; p < 0.01). The sensitivity of lymph node size and positron emission tomography-computed tomography findings for diagnosing LNM were 50.0 % (23/46) and 31.2 % (5/16), respectively, and were thus insufficient. Multivariate analysis identified the serum carcinoembryonic antigen (hazard ratio [HR] 1.830) and carbohydrate antigen 19-9 (HR 2.189) levels, blood transfusion (HR 1.792), intrahepatic metastasis (HR 1.988), and final stage (HR 8.684) as prognostic factors for overall survival, but lymph node enlargement was not identified as a prognostic factor.
  
  
  CONCLUSIONS
  Preoperative evaluation of LNM proved to be difficult, and survival time in ICC patients with lymph node enlargement was prolonged as a result of hepatectomy. Thus, ICC patients with preoperative lymph node enlargement should not be prematurely deemed non-curative cases.
authors.affiliation: Kyushu Study Group of Liver Surgery, 2-1001-1 Kubara, Omura, Nagasaki, 856-8652, Japan.
authors.forename: Tomohiko
authors.initials: T
authors.lastname: Adachi
authors.forename: Susumu
authors.initials: S
authors.lastname: Eguchi
authors.forename: Toru
authors.initials: T
authors.lastname: Beppu
authors.forename: Shinichi
authors.initials: S
authors.lastname: Ueno
authors.forename: Masayuki
authors.initials: M
authors.lastname: Shiraishi
authors.forename: Koji
authors.initials: K
authors.lastname: Okuda
authors.forename: Yo-Ichi
authors.initials: Y
authors.lastname: Yamashita
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Kondo
authors.forename: Atsushi
authors.initials: A
authors.lastname: Nanashima
authors.forename: Masayuki
authors.initials: M
authors.lastname: Ohta
authors.forename: Yuko
authors.initials: Y
authors.lastname: Takami
authors.forename: Tomoaki
authors.initials: T
authors.lastname: Noritomi
authors.forename: Kenji
authors.initials: K
authors.lastname: Kitahara
authors.forename: Hikaru
authors.initials: H
authors.lastname: Fujioka
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D018281:Cholangiocarcinoma / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000401:mortality*; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011300:Preoperative Care; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D055815:Young Adult