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

2019Journal article Open access
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dc.contributor.authorSahara, K
dc.contributor.authorTsilimigras, D
dc.contributor.authorMerath, K
dc.contributor.authorBagante, F
dc.contributor.authorGuglielmi, A
dc.contributor.authorAldrighetti, L
dc.contributor.authorWeiss, M
dc.contributor.authorBauer, T
dc.contributor.authorAlexandrescu, S
dc.contributor.authorPoultsides, G
dc.contributor.authorMaithel, S
dc.contributor.authorPinto Marques, H
dc.contributor.authorMartel, G
dc.contributor.authorPulitano, C
dc.contributor.authorShen, F
dc.contributor.authorSoubrane, O
dc.contributor.authorKoerkamp, B
dc.contributor.authorMatsuyama, R
dc.contributor.authorEndo, I
dc.contributor.authorPawlik, T
dc.date.accessioned2021-10-08T14:38:31Z
dc.date.available2021-10-08T14:38:31Z
dc.date.issued2019
dc.description.abstractBackground: 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.pt_PT
dc.description.versioninfo:eu-repo/semantics/publishedVersionpt_PT
dc.identifier.citationAnn Surg Oncol. 2019 Sep;26(9):2959-2968.pt_PT
dc.identifier.doi10.1245/s10434-019-07483-9.pt_PT
dc.identifier.urihttp://hdl.handle.net/10400.17/3871
dc.language.isoengpt_PT
dc.peerreviewedyespt_PT
dc.publisherSpringerpt_PT
dc.subjectHCC CIRpt_PT
dc.subjectAgedpt_PT
dc.subjectFemalept_PT
dc.subjectBile Duct Neoplasms / secondarypt_PT
dc.subjectBile Duct Neoplasms / surgery*pt_PT
dc.subjectCholangiocarcinoma / pathologypt_PT
dc.subjectCholangiocarcinoma / surgery*pt_PT
dc.subjectMalept_PT
dc.subjectFollow-Up Studiespt_PT
dc.subjectHepatectomy / mortality*pt_PT
dc.subjectHumanspt_PT
dc.subjectLymph Node Excision / mortality*pt_PT
dc.subjectLymph Nodes / pathology*pt_PT
dc.subjectMidlle Agedpt_PT
dc.subjectLymphatic Metastasispt_PT
dc.subjectNeoplasm Stagingpt_PT
dc.subjectPrognosispt_PT
dc.subjectSurvival Ratept_PT
dc.subjectTherapeutic Index*pt_PT
dc.titleTherapeutic Index Associated with Lymphadenectomy Among Patients with Intrahepatic Cholangiocarcinoma: Which Patients Benefit the Most from Nodal Evaluation?pt_PT
dc.typejournal article
dspace.entity.typePublication
oaire.citation.endPage2968pt_PT
oaire.citation.startPage2959pt_PT
oaire.citation.titleAnnals of Surgical Oncologypt_PT
oaire.citation.volume26pt_PT
rcaap.rightsopenAccesspt_PT
rcaap.typearticlept_PT

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