临床与病理评估无淋巴结转移的肝内胆管癌患者术后预后对比

目的:比较肝内胆管癌(intrahepatic cholangiocarcinoma,ICC)中临床评估无淋巴结转移且未行淋巴结切除(clinically node-negative without lymphadenectomy,cN0/LND-)和病理评估无淋巴结转移(pathologically node-neg...

Comparison of prognosis between clinically node-negative and pathologically node-negative intrahepatic cholangiocarcinoma after hepatectomy

  Objective  To compare the overall survival (OS) of patients with clinically node-negative [without lymphadenectomy (cN0/LND-)] and pathologically node-negative (pN0) intrahepatic cholangiocarcinoma (ICC) after hepatectomy and investigate whether cN0 status could be considered a reliable substitute for pN0 status when determining the prognosis of ICC patients.  Methods  Patients with ICC without distant metastasis who underwent hepatectomy, registered in the Surveillance Epidemiology and End Result (SEER) database, between 2004 and 2017 were retrospectively enrolled. Propensity-score matching (PSM) was performed to control selection bias of the following three pairs of groups: cN0/LND- vs. pN0 [number of harvested lymph nodes (HLN)>0]; cN0/LND- vs. pN0 (number of HLN≥6), and pN0 (number of HLN≥6) vs. pN0 (number of HLN<6). OS was analyzed using the Kaplan–Meier method and Cox proportional hazards regression.  Results  After PSM, the pN0 group (number of HLN>0) showed a significantly longer median OS than the cN0/LND-group (54 vs. 44 months, P=0.038). Multivariate analyses showed that pN0 status (number of HLN>0) was an independent prognostic factor for OS (P<0.05). Furthermore, pN0 patients with at least six HLN showed a significantly longer median OS than cN0/LND- patients (72 vs. 44 months, P=0.037), irrespective of T stage. The difference in median OS between the pN0 (number of HLN≥6) and pN0 (number of HLN<6) groups was marginally significant (72 vs. 50 months, P=0.064).  Conclusions  pN0 patients with ICC who underwent hepatectomy showed better OS than cN0/LND- patients. Especially, pN0 patients with at least 6 HLN showed much longer OS than cN0/LND- patients. Thus, in patients with ICC, cN0 status should not be considered a reliable substitute for pN0 status when determining prognosis. Routine lymphadenectomy is recommended even for patients with clinically node-negative ICC.