Patterns and prognostic value of lymph node dissection for resected perihilar cholangiocarcinoma
Kai Mao
Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
Departments of Hepatobiliary Surgery Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
These authors contributed to this work equally.Search for more papers by this authorJieqiong Liu
Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
Department of Breast Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China,
Department of Surgery, Johns Hopkins University, Baltimore, Maryland, USA
These authors contributed to this work equally.Search for more papers by this authorJian Sun
Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
Departments of Hepatobiliary Surgery Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
Search for more papers by this authorJianlong Zhang
Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
Departments of Hepatobiliary Surgery Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
Search for more papers by this authorJie Chen
Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
Departments of Hepatobiliary Surgery Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
Search for more papers by this authorTimothy M. Pawlik
Department of Surgery, Johns Hopkins University, Baltimore, Maryland, USA
Search for more papers by this authorLisa K. Jacobs
Department of Surgery, Johns Hopkins University, Baltimore, Maryland, USA
Search for more papers by this authorCorresponding Author
Zhiyu Xiao
Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
Departments of Hepatobiliary Surgery Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
Correspondence
Zhiyu Xiao and Jie Wang, Guangdong Provincial Key Laboratory of Malignant ,Tumor Epigenetics and Gene Regulation, and Department of Hepatobiliary Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 33# Yingfeng Road, Guangzhou, Guangdong Province 510280, China. Email: [email protected]; [email protected]
Search for more papers by this authorCorresponding Author
Jie Wang
Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
Departments of Hepatobiliary Surgery Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
Correspondence
Zhiyu Xiao and Jie Wang, Guangdong Provincial Key Laboratory of Malignant ,Tumor Epigenetics and Gene Regulation, and Department of Hepatobiliary Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 33# Yingfeng Road, Guangzhou, Guangdong Province 510280, China. Email: [email protected]; [email protected]
Search for more papers by this authorKai Mao
Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
Departments of Hepatobiliary Surgery Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
These authors contributed to this work equally.Search for more papers by this authorJieqiong Liu
Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
Department of Breast Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China,
Department of Surgery, Johns Hopkins University, Baltimore, Maryland, USA
These authors contributed to this work equally.Search for more papers by this authorJian Sun
Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
Departments of Hepatobiliary Surgery Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
Search for more papers by this authorJianlong Zhang
Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
Departments of Hepatobiliary Surgery Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
Search for more papers by this authorJie Chen
Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
Departments of Hepatobiliary Surgery Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
Search for more papers by this authorTimothy M. Pawlik
Department of Surgery, Johns Hopkins University, Baltimore, Maryland, USA
Search for more papers by this authorLisa K. Jacobs
Department of Surgery, Johns Hopkins University, Baltimore, Maryland, USA
Search for more papers by this authorCorresponding Author
Zhiyu Xiao
Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
Departments of Hepatobiliary Surgery Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
Correspondence
Zhiyu Xiao and Jie Wang, Guangdong Provincial Key Laboratory of Malignant ,Tumor Epigenetics and Gene Regulation, and Department of Hepatobiliary Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 33# Yingfeng Road, Guangzhou, Guangdong Province 510280, China. Email: [email protected]; [email protected]
Search for more papers by this authorCorresponding Author
Jie Wang
Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
Departments of Hepatobiliary Surgery Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
Correspondence
Zhiyu Xiao and Jie Wang, Guangdong Provincial Key Laboratory of Malignant ,Tumor Epigenetics and Gene Regulation, and Department of Hepatobiliary Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 33# Yingfeng Road, Guangzhou, Guangdong Province 510280, China. Email: [email protected]; [email protected]
Search for more papers by this authorAbstract
Background and Aim:
Lymph node metastasis is a major prognostic factor for perihilar cholangiocarcinoma (PHC). However, prognostic significance of extent of node dissection, lymph node ratio (LNR), and number and location of positive nodes remain unclear. We aimed to evaluate whether node status, LNR, or number or location of positive nodes are independent factors for staging in PHC and to determine the minimum requirements for node examination.
Methods:
The Surveillance, Epidemiology, and End Results database was used to identify 1116 resected PHCs from 1998 to 2008. The correlation between nodal status and survival was analyzed retrospectively.
Results:
Lymph node metastasis occurred in 43.4% patients and was an independent predictor for overall survival and cancer-specific survival. No survival benefit was observed for an increasing number of node retrieval in node-positive patients. However, in node-negative patients, ≥13 node dissection was of more survival benefit than 3 ≤ total lymph node count (TLNC) ≤ 12 and TLNC < 3 (5-year overall survival: 52.8% vs 39.7% vs 26.3%, P = 0.001; 5-year cancer-specific survival: 60.6% vs 46.3% vs 30.0%, P = 0.001). No difference in survival between patients with regional and distant node involvement was found. Survival for patients with greater than three positive nodes was significantly worse than that for those with three or less (relative ratio: 1.466, P = 0.001). And patients with LNR > 0.27 also had unfavorable prognosis (relative ratio: 1.376, P = 0.001).
Conclusions:
We determined that to adequately assess nodal status of this life-threatening disease, 13 or more nodes retrieval should be considered. Number of positive nodes and LNR rather than location of metastatic nodes may be defined as parameters for staging of PHC.
Supporting Information
Table S1 Baseline characteristics.
Figure S1 The stepwise extraction process from SEER database.
Figure S2 Postoperative radiotherapy (PORT) failed to provide survival benefit for PHC patients, regardless of nodal status. (median overall survival time, 14 vs. 17 months; 3-year OS 17.4% vs. 22.3%; P = 0.083).
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| jgh13072-sup-0001-Figure_1.tifTIFF image, 1.2 MB | Supporting info item |
| jgh13072-sup-0002-Figure_2.tifTIFF image, 710.3 KB | Supporting info item |
| jgh13072-sup-0003-Table_1.docxWord 2007 document , 17.2 KB | Supporting info item |
Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
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