Prognostic Factors And Significance Of Lymphadenectomy In Intrahepatic Cholangiocarcinoma

ObjectiveTo explore the factors affecting the prognosis of ICC patients after radical resection and the significance of lymph node dissection.MethodsThis study retrospectively analyzed the data of patients who underwent radical resection in the Department of Hepatobiliary Surgery of Hunan Provincial People’s Hospital from January 2014 to December 2018.Gender,age,history of viral hepatitis,history of biliary parasites,preoperative CA19-9,preoperative AFP,preoperative CEA,preoperative liver function,tumor size,tumor with sub-foci,Vascular invasion、nerve invasion,operation time,intraoperative blood loss data,postoperative complications,lymphatic metastasis,and postoperative follow-up data were analyzed.Survival analysis was performed by the Kaplan-Meier method,and the prognostic factors were compared by the log-rank test;Independent ICC prognostic factors were analyzed by the Cox regression model.According to the status of the lymph nodes,dividing patients whose lymph nodes have been dissected into two groups,the univariate analysis of lymph node metastasis were analyzed by X~2 test or Fisher’s exact test and multivariate analysis were calculated by logistic regression;P<0.05 was statistically significant in data analysis.ResultsA total of 146 patients in this group,135 patients were followed up.The median follow-up time was 32 months(3-68 months).The 1-,3-,and 5-years disease-free survival(DFS)rates were 61.5%,23.5%,and 3.2%,respectively,The median disease-free survival duration was 17 months;The 1-,3-,and 5-year overall survival(OS)rates were 75.6%,35.1%,and 13.6%,respectively.The median overall survival time was 28 months.On multivariate analysis,factors influencing disease-free survival included lymph node dissection(P=0.024),tumor size(P=0.008),preoperative CA19-9(P=0.006),and tumor with sub-foci(P=0.008).Factors influencing overall survival included Lymph node dissection(P=0.044),tumor size(P=0.002),preoperative CA19-9(P=0.044),vascular invasion(P=0.041),tumor with sub-foci(P=0.004).According to whether lymph node dissection was performed or not,it was divided into two groups: lymph node dissection(LND)group(72 cases)and non-lymphadenectomy(NL)group(63 cases).The 1-,3-,and 5-year disease-free survival of the LND group were 65.2%,35.3%,and 4.4%,respectively,and median DFS duration was 23 months;the 1,3,and 5-year DFS of the NL group were 57.1%,11.5%,and 3.8%,respectively,and the median DFS duration was 16 months.The DFS of the LND group was better than that of the NL group.The 1-,3-,and 5-year OS of the LND group(77.8%,49.1%,and 14.6%,respectively)were significantly better than those of the NL group(73.0%,19.6% and 13.1%,respectively).The median survival duration of the LND group was 35 months,and the median survival duration of the NL group was 21 months;The 1-,3-,and 5-year DFS rates in the negative group(N0)were 85.7%,45.6%,and 6.5%,respectively.The median DFS duration was33 months;The 1-,3-,and 5-year DFS rates in the positive group(N1)were 21.7%,13.0%,and 0,respectively,and the median DFS duration was 9 months.The 1-,3-,and 5-year OS rates in the N0 group were 95.9%,61.2%,and 19.4%,respectively,and the median survival duration was 47 months;the 1-,3-,and 5-year OS rates in the N1 group were 39.1%,23.5% and 0,respectively.The median survival duration was 11 months.The NO group was significantly better than that of the N1 group.CA19-9(P=0.029)and the tumor size(P=0.005)are independent risk factors for lymph node metastasis(LNM)in patients with ICC.Conclusions1.The tumor size> 5cm,high preoperative CA19-9 levels,and tumor with sub-foci are independent risk factors that affect the DFS of ICC patients after radical resection;the tumor size> 5cm,high preoperative CA19-9 levels,tumor with sub-foci occurrences and tumor invasion of blood vessels are independent risk factors that affect the overall survival time of ICC patients after radical resection.Lymph node dissection is a protective factor for the survival of patients with radical resection of ICC.2.The high level of CA19-9 preoperatively and the tumor size>5cm are independent risk factors that affect the LNM in ICC patients.