title: Impact of lymph node status in patients with intrahepatic cholangiocarcinoma treated by major hepatectomy: a review of the National Cancer Database.
abstract: BACKGROUND
  Routine lymphadenectomy in the surgical treatment of intrahepatic cholangiocarcinoma (ICC) is not routinely performed. We aim to define predictive indicators of survival in patients with positive lymph nodes.
  
  
  METHODS
  The National Cancer Data Base (NCDB) was queried for patients who underwent major hepatectomy for ICC between 1998 and 2011. Clinical and pathologic data were assessed using uni- and multi-variate analyses. A sub-analysis was performed on the 160 patients with positive lymph nodes.
  
  
  RESULTS
  Of 849 patients with lymph node data, 57% had at least one lymph node examined. Median survival for lymph node negative patients was 37 months versus 15 months for lymph node positive patients. In lymph node positive patients, poorer survival was associated with not receiving chemotherapy (HR 1.83, p = 0.003), tumor size > 5 cm (p = 0.029), and older age (p < 0.0001). Lymph node positive patients age less than 45 had a median survival of 27 months.
  
  
  CONCLUSIONS
  Overall survival in patients with lymph node metastases from ICC is poor. Adjuvant therapy was associated with a longer survival in lymph node positive patients, although prospective data are needed. Routine lymphadenectomy should be strongly considered to provide prognostic information and guidance for adjuvant therapy.
authors.affiliation: Hepatobiliary and Pancreatic Surgery Program, Providence Cancer Center, Portland, OR, USA.
authors.forename: Zeljka
authors.initials: Z
authors.lastname: Jutric
authors.affiliation: Hepatobiliary and Pancreatic Surgery Program, Providence Cancer Center, Portland, OR, USA.
authors.forename: W Cory
authors.initials: WC
authors.lastname: Johnston
authors.affiliation: Hepatobiliary and Pancreatic Surgery Program, Providence Cancer Center, Portland, OR, USA.
authors.forename: Helena M
authors.initials: HM
authors.lastname: Hoen
authors.affiliation: Hepatobiliary and Pancreatic Surgery Program, Providence Cancer Center, Portland, OR, USA.
authors.forename: Pippa H
authors.initials: PH
authors.lastname: Newell
authors.affiliation: Hepatobiliary and Pancreatic Surgery Program, Providence Cancer Center, Portland, OR, USA.
authors.forename: Maria A
authors.initials: MA
authors.lastname: Cassera
authors.affiliation: Hepatobiliary and Pancreatic Surgery Program, Providence Cancer Center, Portland, OR, USA; Providence Cancer Center, Portland, OR, USA; Gastrointestinal and Minimally Invasive Surgery Division, The Oregon Clinic, Portland, OR, USA.
authors.forename: Chet W
authors.initials: CW
authors.lastname: Hammill
authors.affiliation: Hepatobiliary and Pancreatic Surgery Program, Providence Cancer Center, Portland, OR, USA; Providence Cancer Center, Portland, OR, USA; Gastrointestinal and Minimally Invasive Surgery Division, The Oregon Clinic, Portland, OR, USA.
authors.forename: Ronald F
authors.initials: RF
authors.lastname: Wolf
authors.affiliation: Hepatobiliary and Pancreatic Surgery Program, Providence Cancer Center, Portland, OR, USA; Providence Cancer Center, Portland, OR, USA; Gastrointestinal and Minimally Invasive Surgery Division, The Oregon Clinic, Portland, OR, USA. Electronic address: phansen@orclinic.com.
authors.forename: Paul D
authors.initials: PD
authors.lastname: Hansen
mesh_terms: D000328:Adult; D000368:Aged; D001650:Bile Duct Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D018281:Cholangiocarcinoma / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D016208:Databases, Factual; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008197:Lymph Node Excision / Q000009:adverse effects / Q000401:mortality; D008198:Lymph Nodes / Q000473:pathology / Q000601:surgery*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States