Lee Byung Min, Choi Jin-Young, Seong Jinsil
Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea.
Department of Radiation Oncology, Uijeongbu St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea.
Liver Cancer. 2023 Jan 18;12(3):218-228. doi: 10.1159/000529201. eCollection 2023 Aug.
We aimed to investigate the significance of lymph node metastasis from hepatocellular carcinoma and the efficacy of local treatment.
We included patients diagnosed hepatocellular carcinoma with lymph node metastasis. The pattern of lymph node metastasis was evaluated based on imaging examinations and stratified by three locations: regional (group A), beyond regional intra-abdomen (group B), and extra-abdomen (group C) lymph node metastasis.
Among 14,474 patients, 852 (5.8%) were identified as having lymph node metastasis. Regarding the location of presentation, group A showed the highest incidence, followed by groups B and C. The 1-year overall survival of patients was 31.7%. The survival significantly differed according to the location of lymph node metastasis. The 1-year overall survival rates were 39.8%, 25.5%, and 22.2% in groups A, B, and C, respectively. All patients underwent systemic treatment, with others receiving additional local treatment. Local treatment yielded superior overall survival compared with no local treatment. After propensity score matching, local treatment was associated with improved survival. Additionally, patients were stratified based on disease status at the time of diagnosis of lymph node metastasis: lymph node alone and combined extra-nodal metastasis. The survival benefits of local treatment were observed in both groups.
Our findings demonstrated the clinical significance of lymph node metastasis from hepatocellular carcinoma, which was well discriminated according to location, favoring regional metastasis. In patients with hepatocellular carcinoma presenting lymph node metastasis, active application of local treatment for lymph node metastasis can improve oncologic outcomes.
我们旨在研究肝细胞癌淋巴结转移的意义以及局部治疗的疗效。
我们纳入了诊断为肝细胞癌伴淋巴结转移的患者。根据影像学检查评估淋巴结转移模式，并按三个部位进行分层：区域（A组）、腹腔内区域外（B组）和腹腔外（C组）淋巴结转移。
在14474例患者中，852例（5.8%）被确定有淋巴结转移。就转移部位而言，A组发病率最高，其次是B组和C组。患者的1年总生存率为31.7%。根据淋巴结转移部位的不同，生存率有显著差异。A、B、C组的1年总生存率分别为39.8%、25.5%和22.2%。所有患者均接受了全身治疗，其他患者还接受了额外的局部治疗。与未进行局部治疗相比，局部治疗的总生存率更高。在进行倾向评分匹配后，局部治疗与生存率提高相关。此外，根据淋巴结转移诊断时的疾病状态对患者进行分层：单纯淋巴结转移和合并淋巴结外转移。两组均观察到局部治疗的生存获益。
我们的研究结果证明了肝细胞癌淋巴结转移的临床意义，根据转移部位可很好地区分，区域转移更为常见。在出现淋巴结转移的肝细胞癌患者中，积极应用局部治疗可改善肿瘤学结局。
