Scholz Constantin, Gerber Tiemo Sven, Hoppe-Lotichius Maria, Gröger Lisa Katherina, Renger Franziska, Passalacqua Monia, Margies Rabea, Straub Beate Katharina, Foerster Friedrich, Weinmann Arndt, Tagkalos Evangelos, Bartsch Fabian, Lang Hauke
Department of General, Visceral and Transplant Surgery, Germany.
Institute of Pathology, Germany; Institute of Pathology, Worms Hospital, Worms, Germany.
Eur J Surg Oncol. 2025 Sep;51(9):110143. doi: 10.1016/j.ejso.2025.110143. Epub 2025 May 11.
Extracapsular tumor spread (ECS) in lymph nodes is a known predictor of recurrence and decreased survival across various malignancies, including breast and head and neck cancers. However, its prognostic value in patients with intrahepatic cholangiocarcinoma (iCCA) undergoing curative surgery has not yet been explored.
A retrospective cohort study was conducted, including all patients with lymph node-positive disease (N1) who underwent curative resection for iCCA between 2008 and November 2023. Patients were followed up for at least one year postoperatively. Cases with ECS-positive lymph nodes (N1/ECS+) were compared to those without extracapsular tumor infiltration (N1/ECS-). Statistical analyses included the T-test for continuous variables and the Chi-square test for categorical variables. Survival outcomes were evaluated using the Kaplan-Meier method.
70 patients with N1 disease following potentially curative resection were included. Baseline characteristics were comparable between groups (N1/ECS + n = 30, N1/ECS- n = 40), with no significant differences in age (p = 0.853), resection type (p = 0.511), T-stage (p = 0.785), resection margins (p = 0.687) or the number of tumor-positive lymph nodes (p = 0.052). The median overall survival (OS) was 17.2 months in the N1/ECS + group and 17.3 months in the N1/ECS- group (p = 0.466). Similarly, recurrence-free survival (RFS) was not significantly different, with a median of 4.4 months for N1/ECS + patients versus 7.7 months for N1/ECS- patients (p = 0.335).
Extracapsular tumor spread in lymph nodes was not associated with significant differences in overall or recurrence-free survival in patients with intrahepatic cholangiocarcinoma undergoing curative resection. Based on these findings, ECS does not appear to serve as a prognostic predictor of outcomes in this population.
淋巴结包膜外肿瘤扩散（ECS）是包括乳腺癌和头颈癌在内的多种恶性肿瘤复发和生存率降低的已知预测指标。然而，其在接受根治性手术的肝内胆管癌（iCCA）患者中的预后价值尚未得到探索。
进行了一项回顾性队列研究，纳入了2008年至2023年11月期间所有因iCCA接受根治性切除且淋巴结阳性疾病（N1）的患者。患者术后至少随访一年。将ECS阳性淋巴结病例（N1/ECS+）与无包膜外肿瘤浸润病例（N1/ECS-）进行比较。统计分析包括连续变量的T检验和分类变量的卡方检验。使用Kaplan-Meier方法评估生存结局。
纳入70例接受潜在根治性切除后N1期疾病的患者。两组（N1/ECS+ n = 30，N1/ECS- n = 40）的基线特征具有可比性，年龄（p = 0.853）、切除类型（p = 0.511）、T分期（p = 0.785）、切缘（p = 0.687）或肿瘤阳性淋巴结数量（p = 0.052）无显著差异。N1/ECS+组的中位总生存期（OS）为17.2个月，N1/ECS-组为17.3个月（p = 0.466）。同样，无复发生存期（RFS）无显著差异，N1/ECS+患者的中位无复发生存期为4.4个月，N1/ECS-患者为7.7个月（p = 0.335）。
在接受根治性切除的肝内胆管癌患者中，淋巴结包膜外肿瘤扩散与总生存期或无复发生存期的显著差异无关。基于这些发现，ECS似乎不能作为该人群预后的预测指标。
