Khomiak Andrii, Ghaffar Sumaya Abdul, Rodriguez Franco Salvador, Ziogas Ioannis Asterios, Cumbler Ethan, Gleisner Ana Luiza, Del Chiaro Marco, Schulick Richard David, Mungo Benedetto
Division of Surgical Oncology, Department of Surgery, University of Colorado School of Medicine, Aurora, CO 80045, USA.
Cancers (Basel). 2025 Jan 11;17(2):220. doi: 10.3390/cancers17020220.
. Lymph Node Ratio (LNR) is increasingly recognized as an important prognostic factor in various cancer types, with the potential to enhance patient stratification for intrahepatic (ICC) and extrahepatic (ECC) cholangiocarcinoma. The study aimed to assess the impact of LNR on survival in surgically resected patients with ICC and ECC. . This was a retrospective analysis of National Cancer Database (2004-2020) included ICC and ECC (excluding distal bile duct) patients who underwent primary site resection with adequate lymphadenectomy (≥4 LNs excised). Exclusions comprised age < 18 years, distant metastasis, or incomplete key data. LNR was calculated as the ratio of positive LNs to total examined LNs. Survival probabilities were estimated using Kaplan-Meier analysis and Cox regression. . The inclusion criteria were met by 954 patients with ICC and 1607 patients with ECC. In patients with ICC, the median OS time was 62.7 months in LNR0 group, 40.8 months in LNR < 30%, and 25.2 months in LNR ≥ 30% ( < 0.001). In ICC, 3-year OS was 69.3%, 54.6%, and 34% for LNR 0, LNR < 30%, and LNR ≥ 30%, respectively ( < 0.05). When adjusted for age, sex, Charlson-Deyo score, histology, surgical margins, chemo- and radiotherapy using Cox regression, LNR < 30% and LNR ≥ 30% were associated with worse OS in patients with ICC (HR 2.1 (95% CI 1.6-2.7) and HR 2.94 (95% CI 2.3-3.8)) and ECC (HR 2.1 (95% CI 1.8-2.5) and HR 3 (95% CI 2.4-3.7)). . It is well-known that LN-negative patients have significantly better survival than LN-positive patients with ICC and ECC. This study strongly demonstrates that survival prognosis can be further stratified based on LNR for ICC and ECC patients and that it is not simply a binary factor.
淋巴结比率（LNR）越来越被认为是多种癌症类型中的一个重要预后因素，有可能改善肝内胆管癌（ICC）和肝外胆管癌（ECC）患者的分层。本研究旨在评估LNR对接受手术切除的ICC和ECC患者生存的影响。
这是一项对国家癌症数据库（2004 - 2020年）的回顾性分析，纳入了接受原发部位切除及充分淋巴结清扫（切除≥4枚淋巴结）的ICC和ECC（不包括远端胆管）患者。排除标准包括年龄＜18岁、远处转移或关键数据不完整。LNR计算为阳性淋巴结数与总检查淋巴结数之比。生存概率采用Kaplan - Meier分析和Cox回归进行估计。
954例ICC患者和1607例ECC患者符合纳入标准。在ICC患者中，LNR为0组的中位总生存期（OS）时间为62.7个月，LNR＜30%组为40.8个月，LNR≥30%组为25.2个月（P＜0.001）。在ICC中，LNR为0、LNR＜30%和LNR≥30%的患者3年OS率分别为69.3%、54.6%和34%（P＜0.05）。使用Cox回归对年龄、性别、Charlson - Deyo评分、组织学、手术切缘、化疗和放疗进行校正后，LNR＜30%和LNR≥30%与ICC患者（风险比[HR] 2.1（95%置信区间[CI] 1.6 - 2.7）和HR 2.94（95% CI 2.3 - 3.8））及ECC患者（HR 2.1（95% CI 1.8 - 2.5）和HR 3（95% CI 2.4 - 3.7））较差的OS相关。
众所周知，ICC和ECC患者中淋巴结阴性者的生存明显优于淋巴结阳性者。本研究有力地表明，对于ICC和ECC患者，可根据LNR进一步分层生存预后，且它并非简单的二元因素。
