Invasion category-oriented lymph node metastases of cholangiocarcinoma and the prognostic impact
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ORIGINAL ARTICLE
Invasion category-oriented lymph node metastases of cholangiocarcinoma and the prognostic impact Shogo Kobayashi 1,2 & Hiroshi Wada 2 & Akira Tomokuni 2 & Hidenori Takahashi 2 & Kunihito Gotoh 1 & Masato Sakon 2 & Masaki Mori 1,3 & Yuichiro Doki 1 & Hidetoshi Eguchi 1 Received: 19 May 2020 / Accepted: 3 August 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose It was speculated that intrahepatic cholangiocarcinoma (ICC) invasion would influence cancer progression, such as lymph node (LN) metastasis, and the efficacy of LN dissection (LND). The purpose of this study is to evaluate the LN metastatic pattern of intrahepatic cholangiocarcinoma, including the invasion category and prognosis after surgical resection, in order to explore effective LND. Methods We analyzed a prospectively collected cohort for ICC with a previously reported invasion category: hilar type, showing invasion to the main or first branch of Glisson; peripheral type, showing no invasion to less than the third branch; and intermediate type, for all others. Results Data from a total of 180 patients who underwent surgical resection were analyzed (LN dissection in 142 (79%)). In single ICC, hilar type had a higher LN metastatic rate than the others (hilar; 23/45 (51%), intermediate; 7/25 (28%), peripheral; 1/34 (3%)). Although the survival with LN metastasis (LN+) was worse, single and hilar/intermediate ICC LN+ had a better survival than peripheral type LN+ (3-year OS: hilar/intermediate 30–37%, peripheral 0%). The most frequent LN metastatic region was the hepatico-duodenal ligament for all invasion categories, and the LN metastatic region was not related to the survival. In peripheral ICC, LND did not affect the survival. By contrast, hilar/intermediate ICC LN+ had a better survival than did peripheral ICC LN+, and the 3-year OS was ≥ 20%. Conclusion LN metastasis depended on the ICC invasion category in addition to the tumor number, which affected patients’ survival and the need for LND. In hilar-type disease, LN dissection may contribute to the survival. Keywords Intrahepatic cholangiocarcinoma . Invasion category . Lymph node metastasis . Surgical outcome
Abbreviations BTC Biliary tract cancer
CA19-9 CEA
* Shogo Kobayashi [email protected]; [email protected]; [email protected]
Masaki Mori [email protected] Yuichiro Doki [email protected]
Hiroshi Wada [email protected] Akira Tomokuni [email protected]
Carbohydrate antigen 19-9 Carcinoembryonic antigen
Hidetoshi Eguchi [email protected] 1
Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-2 (E2) Yamadaoka, Suita city, Osaka 537-8511, Japan
Kunihito Gotoh [email protected]
2
Department of Gastroenterological Surgery, Osaka International Cancer Institute, Osaka, Japan
Masato Sakon [email protected]
3
Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu Uni
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