淋巴结清扫术和新的 N 分期系统在肝内胆管癌中的作用：来自 SEER 数据库的研究。
The role of lymph node dissection and a new N-staging system for intrahepatic cholangiocarcinoma: a study from the SEER database.
机构信息
Department of Hepatobiliary Surgery, National Clinical Research Center for Cancer Hospital, Beijing, China.
Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
出版信息
J Int Med Res. 2021 Jun;49(6):3000605211012209. doi: 10.1177/03000605211012209.
BACKGROUND
Although the National Comprehensive Cancer Network guidelines recommend routine lymph node dissection (LND) in intrahepatic cholangiocarcinoma (ICC), the role of LND remains controversial, and the node (N) stage is oversimplified.
METHODS
Patients were identified from the Surveillance, Epidemiology, and End Results research data 18 (SEER 18). Propensity score matching (PSM) was used to reduce bias, and Kaplan-Meier curves and Cox proportional hazards models were used to compare overall survival (OS). The best cutoff values were found using X-tile software.
RESULTS
Of 2037 patients included in SEER 18, 1147 underwent LND (56.3%); 389 (34.3%) had pathologically confirmed lymph node metastasis (LNM), and 316 (27.6%) had at least 6 LNDs. The median OS was worse for LND patients (34 months vs. 40 months, respectively), and this result remained after PSM. Male sex, age ≥60 years, tumor size > 5 cm, and LNM were independent prognostic risk factors for ICC. LNM ≥3 was associated with worse OS.
CONCLUSIONS
Only a few LNDs met the requirements per the guidelines. LND does not improve OS in ICC, and the best approach to LND and a better N staging method should be explored further.
背景
尽管国家综合癌症网络指南建议对肝内胆管癌（ICC）进行常规淋巴结清扫（LND），但 LND 的作用仍存在争议，且 N 分期过于简单。
方法
本研究从监测、流行病学和最终结果研究数据 18（SEER 18）中确定了患者。采用倾向评分匹配（PSM）来减少偏倚，并使用 Kaplan-Meier 曲线和 Cox 比例风险模型来比较总生存期（OS）。使用 X-tile 软件确定最佳截断值。
结果
在 SEER 18 中纳入的 2037 例患者中，有 1147 例行 LND（56.3%）；389 例（34.3%）有病理证实的淋巴结转移（LNM），316 例（27.6%）至少清扫了 6 个淋巴结。LND 患者的中位 OS 更差（分别为 34 个月和 40 个月），PSM 后仍如此。男性、年龄≥60 岁、肿瘤直径＞5cm 和 LNM 是 ICC 的独立预后危险因素。LNM≥3 与 OS 更差相关。
结论
只有少数 LND 符合指南要求。LND 并不能改善 ICC 的 OS，应进一步探索 LND 的最佳方法和更好的 N 分期方法。
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