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01-07-2015 | Hepatobiliary Tumors

Prognostic Impact of Preoperative Lymph Node Enlargement in Intrahepatic Cholangiocarcinoma: A Multi-Institutional Study by the Kyushu Study Group of Liver Surgery

Authors: Tomohiko Adachi, MD, PhD, Susumu Eguchi, MD, PhD, Toru Beppu, MD, PhD, Shinichi Ueno, MD, PhD, Masayuki Shiraishi, MD, PhD, Koji Okuda, MD, PhD, Yo-ichi Yamashita, MD, PhD, Kazuhiro Kondo, MD, PhD, Atsushi Nanashima, MD, PhD, Masayuki Ohta, MD, PhD, Yuko Takami, MD, PhD, Tomoaki Noritomi, MD, PhD, Kenji Kitahara, MD, PhD, Hikaru Fujioka, MD, PhD

Published in: Annals of Surgical Oncology | Issue 7/2015

Abstract

Background

Although lymph node metastasis (LNM) has been considered an important prognostic factor for intrahepatic cholangiocarcinoma (ICC), the impact of lymph node enlargement on the prognosis of ICC, and the accuracy of diagnosis of LNM, have not been fully clarified.

Methods

Using a chart review of 225 patients with ICC, we compared survival times between patients with and without lymph node enlargement, and we evaluated the accuracy of diagnosis of LNM. We also performed a multivariate analysis to determine the variables affecting overall survival in the study population.

Results

The survival time of patients without lymph node enlargement was significantly longer than that of patients with lymph node enlargement (median survival time [MST] 43.7 vs. 20.1 months; p = 0.007). However, in the group with enlarged lymph nodes, survival time was prolonged as a result of hepatectomy (MST 20.1 vs. 7.6 months; p < 0.01). The sensitivity of lymph node size and positron emission tomography–computed tomography findings for diagnosing LNM were 50.0 % (23/46) and 31.2 % (5/16), respectively, and were thus insufficient. Multivariate analysis identified the serum carcinoembryonic antigen (hazard ratio [HR] 1.830) and carbohydrate antigen 19-9 (HR 2.189) levels, blood transfusion (HR 1.792), intrahepatic metastasis (HR 1.988), and final stage (HR 8.684) as prognostic factors for overall survival, but lymph node enlargement was not identified as a prognostic factor.

Conclusion

Preoperative evaluation of LNM proved to be difficult, and survival time in ICC patients with lymph node enlargement was prolonged as a result of hepatectomy. Thus, ICC patients with preoperative lymph node enlargement should not be prematurely deemed non-curative cases.

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Ikai I, Itai Y, Okita K, Omata M, Kojiro M, Kobayashi K, et al. Report of the 15th follow-up survey of primary liver cancer. Hepatol Res. 2004;28:21–29.PubMedCrossRef

Endo I, Gonen M, Yopp AC, Dalal KM, Zhou Q, Klimstra D, et al. Intrahepatic cholangiocarcinoma: rising frequency, improved survival, and determinants of outcome after resection. Ann Surg. 2008;248:84–96.PubMedCrossRef

Hyder O, Hatzaras I, Sotiropoulos GC, Paul A, Alexandrescu S, Marques H, et al. Recurrence after operative management of intrahepatic cholangiocarcinoma. Surgery. 2013;153:811-818.PubMedCentralPubMedCrossRef

Ribero D, Pinna AD, Guglielmi A, Ponti A, Nuzzo G, Giulini SM, et al. Surgical approach for long-term survival of patients with intrahepatic cholangiocarcinoma: a multi-institutional analysis of 434 patients. Arch Surg. 2012;147:1107–1113.PubMedCrossRef

de Jong MC, Nathan H, Sotiropoulos GC, Paul A, Alexandrescu S, Marques H, et al. Intrahepatic cholangiocarcinoma: an international multi-institutional analysis of prognostic factors and lymph node assessment. J Clin Oncol. 2011;29:3140–3145.PubMedCrossRef

Uchiyama K, Yamamoto M, Yamaue H, Ariizumi S, Aoki T, Kokudo N, et al. Impact of nodal involvement on surgical outcomes of intrahepatic cholangiocarcinoma: a multicenter analysis by the Study Group for Hepatic Surgery of the Japanese Society of Hepato-Biliary-Pancreatic Surgery. J Hepatobiliary Pancreat Sci. 2011;18:443–452.PubMedCrossRef

Ercolani G, Vetrone G, Grazi GL, Aramaki O, Cescon M, Ravaioli M, et al. Intrahepatic cholangiocarcinoma: primary liver resection and aggressive multimodal treatment of recurrence significantly prolong survival. Ann Surg. 2010;252:107–114.PubMedCrossRef

Shirabe K, Mano Y, Taketomi A, Soejima Y, Uchiyama H, Aishima S. Clinicopathological prognostic factors after hepatectomy for patients with mass-forming type intrahepatic cholangiocarcinoma: relevance of the lymphatic invasion index. Ann Surg Oncol. 2010;17:1816–1822.PubMedCrossRef

Pritchard KI, Julian JA, Holloway CM, McCready D, Gulenchyn KY, George R, et al. Prospective study of 2-[¹⁸F]fluorodeoxyglucose positron emission tomography in the assessment of regional nodal spread of disease in patients with breast cancer: an Ontario clinical oncology group study. J Clin Oncol. 2012;30:1274–1279.PubMedCrossRef

10.

Kidd EA, Siegel BA, Dehdashti F, Rader JS, Mutch DG, Powell MA, et al. Lymph node staging by positron emission tomography in cervical cancer: relationship to prognosis. J Clin Oncol. 2010;28:2108–2113.PubMedCrossRef

11.

Bastiaannet E, Wobbes T, Hoekstra OS, van der Jagt EJ, Brouwers AH, Koelemij R, et al. Prospective comparison of [18F]fluorodeoxyglucose positron emission tomography and computed tomography in patients with melanoma with palpable lymph node metastases: diagnostic accuracy and impact on treatment. J Clin Oncol. 2009;27:4774–4780.PubMedCrossRef

12.

Liver Cancer Study Group of Japan. General rules for the clinical and pathological study of primary liver cancer. 3rd English ed. Tokyo: Kanehara & Co. Ltd; 2010.

13.

Grobmyer SR, Wang L, Gonen M, Fong Y, Klimstra D, et al. Perihepatic lymph node assessment in patients undergoing partial hepatectomy for malignancy. Ann Surg. 2006;244:260–264.PubMedCentralPubMedCrossRef

14.

Noji T, Kondo S, Hirano S, Tanaka E, Suzuki O, Shichinohe T. Computed tomography evaluation of regional lymph node metastases in patients with biliary cancer. Br J Surg. 2008;95:92–96.PubMedCrossRef

15.

Choi SB, Kim KS, Choi JY, Park SW, Choi JS, Lee WJ, et al. The prognosis and survival outcome of intrahepatic cholangiocarcinoma following surgical resection: association of lymph node metastasis and lymph node dissection with survival. Ann Surg Oncol. 2009;16:3048–3056.PubMedCrossRef

16.

Seo S, Hatano E, Higashi T, Nakajima A, Nakamoto Y, Tada M, et al. Fluorine-18 fluorodeoxyglucose positron emission tomography predicts lymph node metastasis, P-glycoprotein expression, and recurrence after resection in mass-forming intrahepatic cholangiocarcinoma. Surgery. 2008;143:769–777.PubMedCrossRef

17.

Knabe M, Günter E, Ell C, Pech O. Can EUS elastography improve lymph node staging in esophageal cancer? Surg Endosc. 2013;27:1196–1202.PubMedCrossRef

18.

Grotenhuis BA, Wijnhoven BP, Poley JW, Hermans JJ, Biermann K, Spaander MC, et al. Preoperative assessment of tumour location and station-specific lymph node status in patients with adenocarcinoma of the gastroesophageal junction. World J Surg. 2013;37:147–155.PubMedCrossRef

19.

Miwa S, Miyagawa S, Kobayashi A, Akahane Y, Nakata T, Mihara M, et al. Predictive factors for intrahepatic cholangiocarcinoma recurrence in the liver following surgery. J Gastroenterol. 2006;41:893–900.PubMedCrossRef

20.

Chen YX, Zeng ZC, Tang ZY, Fan J, Zhou J, et al. Prediction of the lymph node status in patients with intrahepatic cholangiocarcinoma: analysis of 320 surgical cases. Front Oncol. 2011;42:1–6.

21.

Nanashima A, Sakamoto I, Hayashi T, et al. Preoperative diagnosis of lymph node metastasis in biliary and pancreatic carcinomas: evaluation of the combination of multi-detector CT and serum CA19-9 level. Dig Dis Sci. 2010;55:3617–3626.PubMedCrossRef

22.

Saxena A, Chua TC, Sarkar A, Chu F, Morris DL. Clinicopathologic and treatment-related factors influencing recurrence and survival after hepatic resection of intrahepatic cholangiocarcinoma: a 19-year experience from an established Australian hepatobiliary unit. J Gastrointest Surg. 2010;14:1128–1138.PubMedCrossRef

23.

Sano T, Shimada K, Sakamoto Y, Ojima H, Esaki M, Kosuge T. Prognosis of perihilar cholangiocarcinoma: hilar bile duct cancer versus intrahepatic cholangiocarcinoma involving the hepatic hilus. Ann Surg Oncol. 2008;15:590–599.PubMedCrossRef

24.

Adachi T, Eguchi S. Lymph node dissection for intrahepatic cholangiocarcinoma: a critical review of the literature to date. J Hepatobiliary Pancreat Sci. 2014;21(3):162–168.PubMedCrossRef

Title: Prognostic Impact of Preoperative Lymph Node Enlargement in Intrahepatic Cholangiocarcinoma: A Multi-Institutional Study by the Kyushu Study Group of Liver Surgery
Authors: Tomohiko Adachi, MD, PhD
Susumu Eguchi, MD, PhD
Toru Beppu, MD, PhD
Shinichi Ueno, MD, PhD
Masayuki Shiraishi, MD, PhD
Koji Okuda, MD, PhD
Yo-ichi Yamashita, MD, PhD
Kazuhiro Kondo, MD, PhD
Atsushi Nanashima, MD, PhD
Masayuki Ohta, MD, PhD
Yuko Takami, MD, PhD
Tomoaki Noritomi, MD, PhD
Kenji Kitahara, MD, PhD
Hikaru Fujioka, MD, PhD
Publication date: 01-07-2015
Publisher: Springer US
Published in: Annals of Surgical Oncology / Issue 7/2015
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-014-4239-8

At a glance: The STEP trials

Springer Medicine

Prognostic Impact of Preoperative Lymph Node Enlargement in Intrahepatic Cholangiocarcinoma: A Multi-Institutional Study by the Kyushu Study Group of Liver Surgery

Abstract

Background

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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