Prognostic impact of lymph node metastasis in distal cholangiocarcinoma
British Journal of Surgery
Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Japan; Department of Gastroenterological Surgery, Aichi Cancer Centre Hospital, Nagoya, Japan; Department of General Surgery, Toyohashi Municipal Hospital, Toyohashi, Japan; Department of Surgery, Ogaki Municipal Hospital, Ogaki, Japan; Department of Surgery, Anjo Kosei Hospital, Anjo, Japan; Toyota Kosei Hospital, Toyota, Japan; Japanese Red Cross Nagoya Daiichi Hospital, Nagoya, Japan; Japanese Red Cross Nagoya Daini Hospital, Nagoya, Japan; Kiryu Kosei General Hospital, Kiryu, Japan; Yamashita Hospital, Ichinomiya, Japan; Handa City Hospital, Handa, Japan; Social Insurance Chukyo Hospital, Nagoya, Japan; Chubu Rosai Hospital, Nagoya, Japan; Nagoya Ekisaikai Hospital, Nagoya, Japan; Kasugai Municipal Hospital, Kasugai, Japan; Gifu Prefectural Federation of Agricultural Cooperatives for Health and Welfare Kumiai Hospital, Takayama, Japan; Daido Hospital, Nagoya, Japan; Enshu Hospital, Hamamatsu, Japan; Shizuoka Kosei Hospital, Shizuoka, Japan; Tsushima City Hospital, Tsushima, Japan; Tokai Hospital, Nagoya, Japan; Tokai Municipal Hospital, Tokai, South Africa; Yachiyo Hospital, Anjo, Japan; Chita City Hospital, Chita, Russian Federation
Background: The aim of the study was to investigate the prognostic impact of lymph node metastasis in cholangiocarcinoma using three different classifications. Methods: Patients who underwent pancreaticoduodenectomy for distal cholangiocarcinoma in 24 hospitals in Japan between 2001 and 2010 were included. Survival was calculated by means of the Kaplan-Meier method and differences between subgroups were assessed with the log rank test. The Cox proportional hazards model was used to identify independent predictors of survival. χ2 scores were calculated to determine the cut-off value of the number of involved nodes, lymph node ratio (LNR) and total lymph node count (TLNC) for discriminating survival. Results: Some 370 patients were included. The median (range) TLNC was 19 (3-59). Nodal metastasis occurred in 157 patients (42.4 per cent); the median (range) number of involved nodes and LNR were 2 (1-19) and 0-11 (0.02-0.80) respectively. Four or more involved nodes was associated with a significantly shorter median survival (1.3 versus 2.2years; P = 0.001), as was a LNR of at least 0.17 (1.4 versus 2.3years; P = 0.002). Involvement of nodes along the common hepatic artery, present in 21 patients (13.4 per cent), was also associated with a shorter survival (median 1.3 versus 2.1years; P = 0.046). Multivariable analysis among 157 node-positive patients identified the number of involved nodes as an independent prognostic factor (risk ratio 1.87; P = 0.002). Conclusion: The number of involved nodes was a strong predictor of survival in patients with distal cholangiocarcinoma. © 2015 BJS Society Ltd.
adult; aged; Bile Duct Neoplasms; Cholangiocarcinoma; clinical trial; conservative treatment; female; human; intrahepatic bile duct; Japan; Kaplan Meier method; lymph node; lymph node dissection; lymph node metastasis; male; middle aged; mortality; multicenter study; pancreaticoduodenectomy; pathology; procedures; prognosis; prospective study; secondary; very elderly; Adult; Aged; Aged, 80 and over; Bile Duct Neoplasms; Bile Ducts, Intrahepatic; Cholangiocarcinoma; Female; Humans; Japan; Kaplan-Meier Estimate; Lymph Node Excision; Lymph Nodes; Lymphatic Metastasis; Male; Middle Aged; Organ Sparing Treatments; Pancreaticoduodenectomy; Prognosis; Prospective Studies