Abstract:
Objective To compare the overall survival (OS) of patients with clinically node-negative without lymphadenectomy (cN0/LND-) and pathologically node-negative (pN0) intrahepatic cholangiocarcinoma (ICC) after hepatectomy and investigate whether cN0 status could be considered a reliable substitute for pN0 status when determining the prognosis of ICC patients.
Methods Patients with ICC without distant metastasis who underwent hepatectomy, registered in the Surveillance Epidemiology and End Result (SEER) database, between 2004 and 2017 were retrospectively enrolled. Propensity-score matching (PSM) was performed to control selection bias of the following three pairs of groups: cN0/LND- vs. pN0 number of harvested lymph nodes (HLN)>0; cN0/LND- vs. pN0 (number of HLN≥6), and pN0 (number of HLN≥6) vs. pN0 (number of HLN<6). OS was analyzed using the Kaplan–Meier method and Cox proportional hazards regression.
Results After PSM, the pN0 group (number of HLN>0) showed a significantly longer median OS than the cN0/LND-group (54 vs. 44 months, P=0.038). Multivariate analyses showed that pN0 status (number of HLN>0) was an independent prognostic factor for OS (P<0.05). Furthermore, pN0 patients with at least six HLN showed a significantly longer median OS than cN0/LND- patients (72 vs. 44 months, P=0.037), irrespective of T stage. The difference in median OS between the pN0 (number of HLN≥6) and pN0 (number of HLN<6) groups was marginally significant (72 vs. 50 months, P=0.064).
Conclusions pN0 patients with ICC who underwent hepatectomy showed better OS than cN0/LND- patients. Especially, pN0 patients with at least 6 HLN showed much longer OS than cN0/LND- patients. Thus, in patients with ICC, cN0 status should not be considered a reliable substitute for pN0 status when determining prognosis. Routine lymphadenectomy is recommended even for patients with clinically node-negative ICC.