Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima, 890-8520, Japan.
Department of Radiology, Kagoshima University, Kagoshima, Japan.
Int J Clin Oncol. 2022 Jul;27(7):1212-1221. doi: 10.1007/s10147-022-02175-z. Epub 2022 May 11.
Lymphatic metastasis is a major route of metastasis in distal cholangiocarcinoma (DCC). The present study aimed to elucidate the pattern of lymph node (LN) metastasis and the effectiveness of LN dissection and postoperative adjuvant chemotherapy in patients with DCC.
Patients who underwent surgical resection with curative intent for DCC were enrolled. The nomenclature of the LN stations was defined according to the Japanese Society of Hepato-Biliary-Pancreatic Surgery guidelines. Effectiveness of LN dissection of each station was calculated using frequency of LN metastasis to the station and 5-year survival rate of patients with LN metastasis to that station.
Of the 105 patients included in the study, 46 (43.8%) had LN metastasis, and 43 (41.0%) underwent postoperative adjuvant therapy. LN metastasis, serum carbohydrate antigen (CA) 19-9 level > 37 U/mL, and positive bile duct margin were independent risk factors for shorter overall survival (OS). The most common metastatic LN station at surgery was No. 13 (32.7%), followed by No. 12 (19.2%), No. 17 (9.6%), and No. 8 (6.6%). There was no effectiveness of LN dissection of the station No. 8, 14, and 16. Adjuvant chemotherapy was significantly associated with longer OS in patients with LN metastasis but not in those with positive ductal margins or serum CA 19-9 level > 37 U/mL.
Postoperative adjuvant chemotherapy was associated with a better prognosis in patients with DCC and LN metastasis. However, a more effective therapeutic strategy is required to improve the prognosis of patients with other negative prognostic factors.
淋巴转移是远端胆管癌（DCC）转移的主要途径。本研究旨在阐明 DCC 患者淋巴结（LN）转移的模式以及 LN 清扫术和术后辅助化疗的效果。
本研究纳入了接受根治性手术治疗的 DCC 患者。根据日本肝胆胰外科学会指南定义 LN 站的命名。通过 LN 转移到站的频率和 LN 转移患者的 5 年生存率来计算每个站 LN 清扫的效果。
在纳入的 105 例患者中，46 例（43.8%）有 LN 转移，43 例（41.0%）接受了术后辅助治疗。LN 转移、血清碳水化合物抗原（CA）19-9 水平>37 U/mL 和胆管切缘阳性是总生存期（OS）更短的独立危险因素。手术时最常见的转移 LN 站是 No.13（32.7%），其次是 No.12（19.2%）、No.17（9.6%）和 No.8（6.6%）。站 No.8、14 和 16 的 LN 清扫术没有效果。辅助化疗与 LN 转移患者的 OS 延长显著相关，但与胆管切缘阳性或血清 CA 19-9 水平>37 U/mL 患者的 OS 延长无关。
术后辅助化疗与 DCC 和 LN 转移患者的预后较好相关。然而，需要更有效的治疗策略来改善具有其他负预后因素患者的预后。
