肝内胆管癌患者根治性手术中是否应推荐淋巴结清扫术？一项回顾性研究。

Should lymphadenectomy be recommended in radical surgery of intrahepatic cholangiocarcinoma patients? A retrospective study.

作者信息

Zhang Ruoyu, Cao Dayong, Yang Min, Zhang Jiajun, Ye Feng, Huang Ning, Liu Mei, Chen Bo, Wang Liming

机构信息

Department of Hepatobiliary Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Nanli Area, Chaoyang District, Beijing, 100021, China.

Department of Gastrointestinal Surgery, Institute of Geriatric Medicine, Beijing Hospital, National Center of Gerontology, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 10073, China.

出版信息

J Cancer Res Clin Oncol. 2025 Mar 12;151(3):107. doi: 10.1007/s00432-025-06148-3.

DOI:10.1007/s00432-025-06148-3

PMID:40072624

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11903595/

Abstract

PURPOSE

Intrahepatic cholangiocarcinoma (ICC) is an extremely deadly cancer with high recurrence incidence, particularly in patients with lymph node metastasis (LNM). The necessity of lymphadenectomy including lymph node biology (LNB) and dissection (LND) during ICC radical surgery remains debate.

METHODS

We retrospectively analyzed the patients diagnosed with ICC and underwent radical surgery at the Cancer Hospital of the Chinese Academy of Medical Sciences from 2012 to 2023.

RESULTS

A total of 308 ICC patients were involved in this study. pLNM group had poorer OS (P < 0.0001) and poorer DFS (P < 0.0001) compared with pLNM group. Compared to the LN group, LN group exhibited worse OS (P = 0.038) and worse DFS (P = 0.003). After PSM and IPTW, compared with LN group, LNB exhibited longer operation time (IPTW: P = 0.0024) and longer hospitalization days (IPTW: P = 0.0112) with no significant differences in complications, DFS, and OS. Compared with LN group, LND group had no better DFS and OS, only more complications (IPTW: P = 0.0191), longer operation time (all P < 0.001), higher risk of bleeding (all P < 0.05), transfusion (IPTW: P = 0.014) and longer hospitalization days (IPTW: P = 0.0044). Compared with LNB group, LND had longer operation time (P = 0.0227), higher risk of bleeding (P = 0.017) and transfusion (P = 0.0321), and more postoperative complications (P = 0.0425), with no difference in DFS and OS.

CONCLUSION

Lymphadenectomy does not necessarily provide long-term survival or recurrence benefits. LND only achieves the effect of LNB while negatively affects postoperative recovery without survival benefit for ICC patients. LNB can be performed for accurate pathological staging while not all patients may require LND based on their specific circumstances.

摘要

目的

肝内胆管癌（ICC）是一种极具致命性的癌症，复发率高，尤其是在有淋巴结转移（LNM）的患者中。ICC根治性手术中包括淋巴结生物学（LNB）和清扫（LND）的淋巴结切除术的必要性仍存在争议。

方法

我们回顾性分析了2012年至2023年在中国医学科学院肿瘤医院被诊断为ICC并接受根治性手术的患者。

结果

本研究共纳入308例ICC患者。与无淋巴结转移（pLNM）组相比，有淋巴结转移组的总生存期（OS）更差（P < 0.0001），无病生存期（DFS）更差（P < 0.0001）。与淋巴结阴性（LN）组相比，淋巴结阳性组的OS更差（P = 0.038），DFS更差（P = 0.003）。在倾向评分匹配（PSM）和逆概率加权（IPTW）后，与LN组相比，LNB组的手术时间更长（IPTW：P = 0.0024），住院天数更长（IPTW：P = 0.0112），在并发症、DFS和OS方面无显著差异。与LN组相比，LND组的DFS和OS并无改善，只是并发症更多（IPTW：P = 0.0191），手术时间更长（所有P < 0.001），出血风险更高（所有P < 0.05），输血更多（IPTW：P = 0.014），住院天数更长（IPTW：P = 0.0044）。与LNB组相比，LND组的手术时间更长（P = 0.0227），出血风险更高（P = 0.017），输血风险更高（P = 0.0321），术后并发症更多（P = 0.0425），DFS和OS无差异。