Evaluation of prognostic factors and implication of lymph node dissection in intrahepatic cholangiocarcinoma: 10-year experience at a tertiary referral center.
BACKGROUND
Intrahepatic cholangiocarcinoma (ICC) is the second most common primary liver malignancy, and surgical resection remains the only potentially curative treatment. However, the existing literature indicates that those prognostic factors associated with outcome after surgery remain poorly defined.


METHODS
Data were retrospectively collected from 103 patients with ICC who underwent surgical resection between 2005 and 2014. The patients were divided into two groups: one with (D1) and one without (D0) lymph node dissection of hepatic hilum according to the surgery performed. Thereafter, the prognostic values of clinicopathological characteristics were evaluated.


RESULTS
The median overall survival (OS) after surgical resection of ICC was 43.9 months [95% confidence interval (CI), 11.6-76.2 months]. The 1-, 3-, and 5-year OS rates were 85.5%, 52.8%, and 45.6%, respectively. Multivariable analysis showed that lymph node metastases [hazard ratio (HR), 6.70; 95% CI, 2.18-20.55], positive resection margins (HR, 2.67; 95% CI, 1.14-6.23), periductal infiltration (HR, 3.64; 95% CI, 1.27-10.44), and poor differentiation (HR, 2.90; 95% CI, 1.41-5.95) were independently associated with poor survival. There were no significant differences in clinicopathological characteristics between D1 and D0 groups, except for vascular invasion (p = 0.018) and perineural invasion (p = 0.008). In the D1 group, lymph node metastases were associated with late T stages, multiple tumors, and elevated serum carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA19-9) levels.


CONCLUSIONS
Regional lymph node metastasis, positive resection margin, periductal infiltration, and poor differentiation were poor prognostic factors in patients with ICC after curative surgery. Lymph node dissection did not show survival benefits, but was useful for nodal staging. However, lymph node metastases were strongly associated with late T stages, multiple tumors, and elevated serum CEA and CA19-9 levels.
Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC.
Miao-Erh
ME
Chang
School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC. Electronic address: hjlei@vghtpe.gov.tw.
Hao-Jan
HJ
Lei
Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC.
Ming-Huang
MH
Chen
School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Department of Pathology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
Yi-Chen
YC
Yeh
School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
Chung-Pin
CP
Li
Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC.
Yi-Ping
YP
Hung
School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
Cheng-Yuan
CY
Hsia
School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
Chieu-An
CA
Liu
School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
Gar-Yang
GY
Chau
Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC.
Yee
Y
Chao
D000328:Adult; D000368:Aged; D001650:Bile Duct Neoplasms / Q000401:mortality* / Q000601:surgery; D018281:Cholangiocarcinoma / Q000401:mortality* / Q000601:surgery; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012017:Referral and Consultation
cholangiocarcinoma; lymph node dissection; prognostic factors