肝内胆管癌癌症特异性死亡的最佳检查淋巴结数目：一项基于人群的研究。

The optimal number of examined lymph nodes for cancer specific death of intrahepatic cholangiocarcinoma: a population-based study.

作者信息

Ou Chaojia, Zhou Yufan, Tang You, Tan Zhiguo, Peng Chuang, Chen Xu, Li Ou

机构信息

Department of Hepatobiliary Surgery, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, No.61 Jiefang West Road, Changsha, 410005, Hunan, People's Republic of China.

Department of General Surgery, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, 410005, Hunan, People's Republic of China.

出版信息

Discov Oncol. 2025 Apr 16;16(1):531. doi: 10.1007/s12672-025-02322-8.

DOI:10.1007/s12672-025-02322-8

PMID:40237966

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12003220/

Abstract

BACKGROUND

The number of lymph nodes to be removed during tumor resection in patients with intrahepatic cholangiocarcinoma (ICC) has always been a subject of controversy. The correlation between examined lymph nodes (ELN) and cancer-specific mortality (CSM) in individuals with ICC was the purpose of this investigation.

METHODS

Multivariable models were used to analyze data from the Surveillance, Epidemiology, and End Results database on ICC in order to ascertain the connection between ELN count and CSM. Correlation between ELN and cancer-specific survival (CSS) was evaluated by restricted cubic splines (RCS) on a continuous scale. Locally weighted scatterplot smoothing smoother was used to evaluated the hazard ratios (HRs) of ELNs for CSS with the structural breakpoints determined by Chow test.

RESULTS

This investigation incorporated 1335 ICC cases. Independent risk factors for CSM included median household income, race, diagnostic year, tumor grade, clinical stage, pT stage, pN stage, pM stage and ELN count. With the adjustment for covariates, ICC cases showed statistically significant improvements in CSS (HR = 0.88) as the ELN count increased. The best threshold ELN count, as determined by cut-point analysis, was 6, which allowed for accurate CSS probability discrimination.

CONCLUSION

Increasing ELN count indicated better CSS. Our results strongly suggested 6 ELNs as the optimal cut-off number for assessing the standard of lymph node inspection and prognostic classification in ICC.

摘要

背景

肝内胆管癌（ICC）患者肿瘤切除术中需要切除的淋巴结数量一直存在争议。本研究旨在探讨ICC患者的检测淋巴结数量（ELN）与癌症特异性死亡率（CSM）之间的相关性。

方法

使用多变量模型分析监测、流行病学和最终结果数据库中关于ICC的数据，以确定ELN计数与CSM之间的联系。通过连续尺度上的受限立方样条（RCS）评估ELN与癌症特异性生存率（CSS）之间的相关性。使用局部加权散点图平滑法评估ELN对CSS的风险比（HRs），并通过Chow检验确定结构断点。

结果

本研究纳入了1335例ICC病例。CSM的独立危险因素包括家庭收入中位数、种族、诊断年份、肿瘤分级、临床分期、pT分期、pN分期、pM分期和ELN计数。在调整协变量后，随着ELN计数增加，ICC病例的CSS有统计学显著改善（HR = 0.88）。通过切点分析确定的最佳阈值ELN计数为6，这使得能够准确区分CSS概率。