The Discussion On The Characteristics And Treatment Strategies Of Hilar Lymph Node Metastasis In Primary Liver Cancer

ObjectiveBy studying on Primary liver cancer (PLC) with hepatic hilar lymph node metastasis in clinical pathological characteristics, surgical treatment and prognosis, to improve the overall diagnosis and treatment of Primary liver cancer.Meterials and methodsRetrospective analysis during the 2008 January to October 2013 in Affiliated Tumor Hospital of Guangxi Medical University, postoperative pathological diagnosis for primary liver cancer underwent surgical resection, a total of 686 cases selected 165 patients by preoperative imaging diagnosis of hilar lymph nodes were studied. All patients operation according to the same standard resection resection enlarged lymph node dissection evacuation pathological examination in the diagnosis of benign and malignant, of which postoperative pathological diagnosis of hilar metastasis of lymph nodes in patients with 43 cases. Pathology showed no benign lymph node in 122 cases.43 cases of lymph node metastasis were defined as LNM (lymph node metastasis) group, 122 cases without lymph node metastasis were NLNM (no lymph node metastasis) group. Statistical data, such as clinical pathology and prognosis of the patients with the clinical and pathological characteristics,metastasis, metastasis, efficacy and prognosis were analyzed.Results1. The incidence of lymph node metastasis was 6.3% (43/686) in 686 patients with primary hepatic carcinoma, 165 cases with primary hepatic carcinoma and cases with hilar lymph node metastasis were confirmed by postoperative pathology. The proportion of lymph node metastasis was 26.1% (43/165).Postoperative pathological examination showed that the metastasis rate of cholangiocarcinoma was 52% (13/25)that was the highest, and the metastasis rate of hepatocellular carcinoma was the lowest which was 18.7% (23/123).2. The proportion of women in group LNM was 25.6% (11/43), CA19-9 positive ratio was 46.5% (20/43), the proportion of GGT was 74.4% (32/43) was higher than that of NLNM group (P<0.05).3. Intraoperative exploration found performance as a hard lymph node metastasis, multiple, maximum diameter larger than 1 cm, integration and features; lymph node metastasis to liver duodenum ligament is the most common 27/43; transfer mode such as metastasis group, the ratio was 55.8%(24/43).4. The incidence rate of postoperative complications (37.2%) in group LNM was higher than group NLNM (10.6%) (P<0.05).5. The median survival time was 10 months and 34 months respectively in group LNM and group NLNM, the 1-year and 2-year survival rates were 35%,18%3 and 73%, 45%(P<0.05), respectively.6. Single factor analysis showed that the degree of pathological differentiation,the number of lymph nodes, the maximum diameter of lymph nodes, and postoperative radiotherapy and postoperative combination therapy were the factors influencing the prognosis of primary liver cancer.7.Multivariate analysis showed that the degree of pathologic differentiation,the number of lymph nodes, and postoperative radiotherapy were related to the prognosis.Conclusion1. Lymph node metastasis in primary liver cancer is not rare and has a poor prognosis.2. Preoperative imaging examination suggested that the hilar lymph node enlargement should pay more attention to lymph node exploration3. The surgical treatment of primary liver cancer with hilar lymph node metastasis is not ideal, postoperative adjuvant radiotherapy or combined with a variety of treatment may improve the treatment effect.