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Open Access 01-12-2015 | Hepatobiliary Tumors

Lymph Node Micrometastases are Associated with Worse Survival in Patients with Otherwise Node-Negative Hilar Cholangiocarcinoma

Authors: Hendrik T. J. Mantel, MD, Jim K. Wiggers, MD, Joanne Verheij, MD, PhD, Jan J. Doff, MD, PhD, Egbert Sieders, MD, PhD, Thomas M. van Gulik, MD, PhD, Annette S. H. Gouw, MD, PhD, Robert J. Porte, MD, PhD

Published in: Annals of Surgical Oncology | Special Issue 3/2015

Abstract

Background

Lymph node metastases on routine histology are a strong negative predictor for survival after resection of hilar cholangiocarcinoma. Additional immunohistochemistry can detect lymph node micrometastases in patients who are otherwise node negative, but the prognostic value is unsure. The objective of this study was to assess the effect on survival of immunohistochemically detected lymph node micrometastases in patients with node-negative (pN0) hilar cholangiocarcinoma on routine histology.

Methods

Between 1990 and 2010, a total of 146 patients underwent curative-intent resection of hilar cholangiocarcinoma with regional lymphadenectomy at two university medical centers in the Netherlands. Ninety-one patients (62 %) without lymph node metastases at routine histology were included. Micrometastases were identified by multiple sectioning of all lymph nodes and additional immunostaining with an antibody against cytokeratin 19 (K19). The association with overall survival was assessed in univariable and multivariable analysis. Median follow-up was 48 months.

Results

Micrometastases were identified in 16 (5 %) of 324 lymph nodes, corresponding to 11 (12 %) of 91 patients. There were no differences in clinical variables between K19 lymph node-positive and -negative patients. Five-year survival rates in patients with lymph node micrometastases were significantly lower compared to patients without micrometastases (27 vs. 54 %, P = 0.01). Multivariable analysis confirmed micrometastases as an independent prognostic factor for survival (adjusted Hazard ratio 2.4, P = 0.02).

Conclusions

Lymph node micrometastases are associated with worse survival after resection of hilar cholangiocarcinoma. Immunohistochemical detection of lymph node micrometastases leads to better staging of patients who were initially diagnosed with node-negative (pN0) hilar cholangiocarcinoma on routine histology.

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Title: Lymph Node Micrometastases are Associated with Worse Survival in Patients with Otherwise Node-Negative Hilar Cholangiocarcinoma
Authors: Hendrik T. J. Mantel, MD
Jim K. Wiggers, MD
Joanne Verheij, MD, PhD
Jan J. Doff, MD, PhD
Egbert Sieders, MD, PhD
Thomas M. van Gulik, MD, PhD
Annette S. H. Gouw, MD, PhD
Robert J. Porte, MD, PhD
Publication date: 01-12-2015
Publisher: Springer US
Published in: Annals of Surgical Oncology / Issue Special Issue 3/2015
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-015-4723-9

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Lymph Node Micrometastases are Associated with Worse Survival in Patients with Otherwise Node-Negative Hilar Cholangiocarcinoma

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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