Chen Chen, Su Jingbo, Wu Hong, Qiu Yinghe, Song Tianqiang, Mao Xianhan, He Yu, Cheng Zhangjun, Zhai Wenlong, Li Jingdong, Geng Zhimin, Tang Zhaohui
Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China.
Department of Liver Surgery, Liver Transplantation Center, West China Hospital of Sichuan University, Chengdu 610041, China.
Eur J Surg Oncol. 2023 Apr;49(4):780-787. doi: 10.1016/j.ejso.2022.11.008. Epub 2022 Nov 8.
This study aimed to evaluate the prognostic value of lymph node dissection (LND) in node-negative intrahepatic cholangiocarcinoma (ICC) and identify the appropriately total number of lymph nodes examined (TNLE).
Data from node-negative ICC patients who underwent curative intent resection in ten Chinese hepatobiliary centers from January 2010 to December 2018 were collected. Overall survival (OS), relapse-free survival (RFS) and postoperative complications were analyzed. Propensity score matching (PSM) was performed to reduce the bias due to confounding variables in LND group and non-lymph node dissection (NLND) group. The optimal TNLE was determined by survival analysis performed by the X-tile program using the enumeration method.
A total of 637 clinically node-negative ICC patients were included in this study, 74 cases were found lymph node (LN) positive after operation. Among the remaining 563 node-negative ICC patients, LND was associated with longer OS but not RFS before PSM (OS: 35.4 vs 26.0 months, p = 0.047; RFS: 15.0 vs 15.4 months, p = 0.992). After PSM, patients in LND group had better prognosis on both OS and RFS (OS: 38.0 vs 23.0 months, p < 0.001; RFS: 15.0 vs 13.0 months, p = 0.029). There were no statistically differences in postoperative complications. When TNLE was greater than 8, OS (48.5 vs 31.1 months, p = 0.025) and RFS (21.0 vs 13.0 months, p = 0.043) were longer in the group with more dissected LNs.
Routinely LND for node-negative ICC patients is recommended for it helps accurate tumor staging and associates with better prognosis. The optimal TNLE is more than 8.
本研究旨在评估淋巴结清扫术（LND）在淋巴结阴性的肝内胆管癌（ICC）中的预后价值，并确定合适的淋巴结检查总数（TNLE）。
收集2010年1月至2018年12月期间在十个中国肝胆中心接受根治性切除的淋巴结阴性ICC患者的数据。分析总生存期（OS）、无复发生存期（RFS）和术后并发症。进行倾向评分匹配（PSM）以减少LND组和非淋巴结清扫（NLND）组中混杂变量导致的偏差。使用枚举法通过X-tile程序进行生存分析来确定最佳TNLE。
本研究共纳入637例临床淋巴结阴性的ICC患者，术后发现74例淋巴结（LN）阳性。在其余563例淋巴结阴性的ICC患者中，PSM前LND与更长的OS相关，但与RFS无关（OS：35.4个月对26.0个月，p = 0.047；RFS：15.0个月对15.4个月，p = 0.992）。PSM后，LND组患者在OS和RFS方面均有更好的预后（OS：38.0个月对23.0个月，p < 0.001；RFS：15.0个月对13.0个月，p = 0.029）。术后并发症无统计学差异。当TNLE大于8时，淋巴结清扫数量较多的组的OS（48.5个月对31.1个月，p = 0.025）和RFS（21.0个月对13.0个月，p = 0.043）更长。
建议对淋巴结阴性的ICC患者常规进行LND，因为它有助于准确的肿瘤分期并与更好的预后相关。最佳TNLE大于8。
