Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-Ro, Seodaemun-Gu, Seoul, 03722, Republic of Korea.
Department of Radiology, Research Institute of Radiological Science, Center for Clinical Imaging Data Science, College of Medicine, Yonsei University, Seoul, Korea.
Hepatol Int. 2023 Aug;17(4):942-953. doi: 10.1007/s12072-022-10477-7. Epub 2023 Jan 23.
The abnormality of imaging finding of lymph node (LN) has demonstrated unsatisfactory diagnostic accuracy for pathologic lymph node metastasis (LNM). We aimed to develop and validate a simple scoring system predicting LNM in patients with intrahepatic cholangiocarcinoma (iCCA) prior to surgery based on MRI and clinical findings.
We retrospectively enrolled consecutive patients who underwent surgical resection for treatment-naïve iCCA from six institutions between January 2009 and December 2015. Patients who underwent lymph node dissection (LND) were randomly assigned to the training and validation cohorts at a 2:1 ratio, an¹ìd pathologic LN status was evaluated. Patients who did not undergo LND were assigned to the test cohort, and clinical LN status was evaluated. Using MRI and clinical findings, a preoperative LNM score was developed in the training cohort and validated in the validation and test cohorts.
The training, validation, and test cohorts included 102, 53, and 118 patients, respectively. The preoperative LNM score consisted of serum carcinoembryonic antigen and two MRI findings (suspicious LN and bile duct invasion). The preoperative LNM score was associated with pathologic LNM in training (p < 0.001) and validation (p = 0.010) cohorts and clinical LNM in test cohort (p < 0.001). The preoperative LNM score outperformed MRI-suspicious LN alone in predicting pathologic LNM (area under the curve, 0.703 vs. 0.604, p = 0.004). The preoperative LNM score was also associated with overall survival in all cohorts (p < 0.001).
Our preoperative LNM score was significantly associated with pathologic or clinical LNM and outperformed MRI-suspicious LN alone.
淋巴结（LN）影像学异常对病理淋巴结转移（LNM）的诊断准确性并不理想。我们旨在开发和验证一种基于 MRI 和临床发现的简单评分系统，用于预测术前肝内胆管癌（iCCA）患者的 LNM。
我们回顾性纳入了 2009 年 1 月至 2015 年 12 月期间在六家机构接受手术治疗的初治 iCCA 患者。接受淋巴结清扫术（LND）的患者以 2:1 的比例随机分配到训练和验证队列，评估病理 LN 状态。未接受 LND 的患者被分配到测试队列，评估临床 LN 状态。在训练队列中，基于 MRI 和临床发现开发术前 LNM 评分，并在验证和测试队列中进行验证。
训练、验证和测试队列分别纳入了 102、53 和 118 例患者。术前 LNM 评分包括血清癌胚抗原和两个 MRI 发现（可疑 LN 和胆管侵犯）。术前 LNM 评分与训练（p<0.001）和验证（p=0.010）队列的病理 LNM 以及测试队列的临床 LNM 相关。术前 LNM 评分在预测病理 LNM 方面优于 MRI 可疑 LN 单独使用（曲线下面积，0.703 与 0.604，p=0.004）。术前 LNM 评分在所有队列中均与总生存期相关（p<0.001）。
我们的术前 LNM 评分与病理或临床 LNM 显著相关，优于 MRI 可疑 LN 单独使用。
