General and Hepatobiliary Surgery, Department of Surgery, School of Medicine, University of Verona, Piazzale L. Scuro, 10, 37134, Verona, Italy.
Department of Surgery, Humanitas Clinical and Research Center, Humanitas University, Rozzano, Italy.
J Gastrointest Surg. 2019 Jun;23(6):1122-1129. doi: 10.1007/s11605-019-04108-0. Epub 2019 Feb 28.
The role of lymph node dissection (LND) in patients with small intrahepatic cholangiocarcinoma (ICC) is still under debate. The aims of this study were to compare the lymph node (LN) status and its correlation with survival among patients with ICC stratified by tumor size.
A retrospective analysis of a multi-institutional series of 259 patients undergoing curative-intent surgery was carried out. Patients were stratified into Small-ICC (≤ 3 cm) and Large-ICC (> 3 cm) based on tumor size.
There were 53 and 206 patients in Small-ICC and Large-ICC groups, respectively. The incidence of LND was 62% among Small-ICC patients and 78% among Large-ICC patients (p = 0.016). LN metastases were identified in 30.3% and 38.5% of Small-ICC and Large-ICC patients, respectively (p = 0.37). No differences in terms of number of harvested LN and LN metastases were identified comparing Small- and Large-ICC patients. The 5-year overall survival (OS) was 52.6% for Small-ICC and 36.2% for Large-ICC (p = 0.024). The 5-year OS according to the LN status (N0 vs N+) was 84.8% and 36.0% (p = 0.032) in Small-ICC, and 45.7% and 12.1% in Large-ICC (p < 0.001), respectively.
While Small-ICC patients with no LN metastasis had a good long-term survival, the LN resulted in an important variable associated with survival also for patients in this group. Moreover, the incidence of LN metastasis did not differ when comparing Small-ICC and Large-ICC patients, suggesting that LND is mandatory in the surgical treatment of ICC regardless of tumor size.
淋巴结清扫术（LND）在小肝内胆管癌（ICC）患者中的作用仍存在争议。本研究旨在比较肿瘤大小分层的 ICC 患者的淋巴结（LN）状态及其与生存的相关性。
对多机构系列 259 例接受根治性手术的患者进行回顾性分析。根据肿瘤大小将患者分为小 ICC（≤3cm）和大 ICC（>3cm）。
小 ICC 组和大 ICC 组分别有 53 例和 206 例患者。小 ICC 患者的 LND 发生率为 62%，大 ICC 患者为 78%（p=0.016）。小 ICC 和大 ICC 患者的 LN 转移发生率分别为 30.3%和 38.5%（p=0.37）。小 ICC 和大 ICC 患者的 LN 检出数量和 LN 转移无差异。小 ICC 的 5 年总生存率（OS）为 52.6%，大 ICC 为 36.2%（p=0.024）。根据 LN 状态（N0 与 N+），小 ICC 的 5 年 OS 分别为 84.8%和 36.0%（p=0.032），大 ICC 分别为 45.7%和 12.1%（p<0.001）。
虽然无 LN 转移的小 ICC 患者具有良好的长期生存，但 LN 也是影响这组患者生存的重要因素。此外，小 ICC 和大 ICC 患者的 LN 转移发生率无差异，提示无论肿瘤大小如何，LND 都是 ICC 手术治疗的必要手段。
