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

Sahara, KTsilimigras, DMerath, KBagante, FGuglielmi, AAldrighetti, LWeiss, MBauer, TAlexandrescu, SPoultsides, GMaithel, SPinto Marques, HMartel, GPulitano, CShen, FSoubrane, OKoerkamp, BMatsuyama, REndo, IPawlik, T2021-10-082021-10-082019Ann Surg Oncol. 2019 Sep;26(9):2959-2968.http://hdl.handle.net/10400.17/3871Background: 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.engHCC CIRAgedFemaleBile Duct Neoplasms / secondaryBile Duct Neoplasms / surgery*Cholangiocarcinoma / pathologyCholangiocarcinoma / surgery*MaleFollow-Up StudiesHepatectomy / mortality*HumansLymph Node Excision / mortality*Lymph Nodes / pathology*Midlle AgedLymphatic MetastasisNeoplasm StagingPrognosisSurvival RateTherapeutic Index*Therapeutic Index Associated with Lymphadenectomy Among Patients with Intrahepatic Cholangiocarcinoma: Which Patients Benefit the Most from Nodal Evaluation?journal article10.1245/s10434-019-07483-9.