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Erschienen in: Annals of Surgical Oncology 9/2019

31.05.2019 | Hepatobiliary Tumors

Therapeutic Index Associated with Lymphadenectomy Among Patients with Intrahepatic Cholangiocarcinoma: Which Patients Benefit the Most from Nodal Evaluation?

verfasst von: Kota Sahara, MD, Diamantis I. Tsilimigras, MD, Katiuscha Merath, MD, Fabio Bagante, MD, Alfredo Guglielmi, MD, Luca Aldrighetti, MD, Matthew Weiss, MD, Todd W. Bauer, MD, Sorin Alexandrescu, MD, George A. Poultsides, MD, Shishir K. Maithel, MD, Hugo P. Marques, MD, Guillaume Martel, MD, Carlo Pulitano, MD, Feng Shen, MD, Olivier Soubrane, MD, B. Groot Koerkamp, MD, Ryusei Matsuyama, MD, PhD, Itaru Endo, MD, PhD, Timothy M. Pawlik, MD, MPH, PhD, FACS

Erschienen in: Annals of Surgical Oncology | Ausgabe 9/2019

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Abstract

Background

Although lymph node metastasis (LNM) is an important prognostic indicator for patients with intrahepatic cholangiocarcinoma (ICC), the benefit and indication for lymphadenectomy remain unclear.

Methods

Patients diagnosed with ICC between 1990 and 2016 were identified in the international multi-institutional dataset. To determine the survival benefit from lymphadenectomy, the therapeutic index was calculated by multiplying the frequency of LNM in a particular group of patients by the 3-year cancer-specific survival (CSS) rate of patients with LNM in that subgroup.

Results

Among 471 patients who met the inclusion criteria, approximately half had LNM (n = 205, 43.5%). The median number of resected and metastatic LNs were 4 [interquartile range (IQR) 2–8] and 0 (IQR 0–1), respectively. Three-year CSS in the entire cohort was 29.9%, reflecting a therapeutic index value of 13.0. The therapeutic index was lower among patients with major vascular invasion (5.4), preoperative carcinoembryonic antigen (CEA) > 5.0 (8.2), and LNM in areas other than the hepatoduodenal ligament (5.2). Of note, a therapeutic index difference of more than 10 points was noted only when examining the number of LNs harvested [1–2 (4.1) vs. 3–6 (16.1) vs. ≥ 7 (17.8)].

Conclusion

The survival benefit derived from lymphadenectomy was poor among patients with major vascular invasion, CEA > 5.0, and LNM in areas other than the hepatoduodenal ligament. Resection of three or more LNs was associated with the highest therapeutic value among patients with LNM.
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Metadaten
Titel
Therapeutic Index Associated with Lymphadenectomy Among Patients with Intrahepatic Cholangiocarcinoma: Which Patients Benefit the Most from Nodal Evaluation?
verfasst von
Kota Sahara, MD
Diamantis I. Tsilimigras, MD
Katiuscha Merath, MD
Fabio Bagante, MD
Alfredo Guglielmi, MD
Luca Aldrighetti, MD
Matthew Weiss, MD
Todd W. Bauer, MD
Sorin Alexandrescu, MD
George A. Poultsides, MD
Shishir K. Maithel, MD
Hugo P. Marques, MD
Guillaume Martel, MD
Carlo Pulitano, MD
Feng Shen, MD
Olivier Soubrane, MD
B. Groot Koerkamp, MD
Ryusei Matsuyama, MD, PhD
Itaru Endo, MD, PhD
Timothy M. Pawlik, MD, MPH, PhD, FACS
Publikationsdatum
31.05.2019
Verlag
Springer International Publishing
Erschienen in
Annals of Surgical Oncology / Ausgabe 9/2019
Print ISSN: 1068-9265
Elektronische ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-019-07483-9

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