Abstract
BackgroundThe evaluation of the nodal status of hepatocellular carcinoma (HCC) is a classic but controversial topic. This study aimed to investigate the incidence of lymph node metastasis (LNM), explore the role of lymph node dissection (LND), and develop and validate a novel model to predict LNM in patients with HCC, not other specified (NOS).MethodsThe study cohort was taken from the Surveillance, Epidemiology, and End Results database. The annual percent change (APC) was calculated using the Joinpoint regression. Survival analyses adopted the competing risk model. The nomogram was constructed based on the least absolute shrinkage and selection operator (LASSO) logistic regression algorithm and validated by calibration curves. The area under the receiver operating characteristic curve (AUROC) was obtained to compare prognostic performance. Decision curve and clinical impact curve analyses were introduced to examine the clinical value of the models.ResultsA total of 8,829 patients were finally enrolled in this study, and 1,346 (15.2%) patients received LND. The LND rate showed no noticeable fluctuation in the last decade, with an APC of 0.5% (P=0.593). LNM was identified in 56 (4.2%) patients and confirmed an independent prognostic factor of HCC patients (P=0.005). There were 2,497 lymph nodes retrieved, and 93 (3.7%) of them were positive. After propensity score matching, LND indicated no direct oncologic benefit and did not worsen competing risks. Moreover, an increased number of lymph nodes retrieved could not improve prognoses. 1,346 patients with LND were further randomly divided into the training and validation sets with the ratio of 1:1. Race, tumor size, clinical T stage, extrahepatic bile duct invasion, and tumor grade were independent risk factors for LNM. The constructed model was well calibrated and showed good discrimination power and net benefits in clinical practice.ConclusionLNM is an independent prognostic factor in HCC, but routine LND seems to be unnecessary in HCC patients. The constructed model could predict the presence of LNM in HCC patients with good performance, which is meaningful to patient stratification and individual treatment strategies optimization.
Highlights
Hepatocellular carcinoma (HCC) accounts for approximately 85%-90% of primary liver cancer and has been a heavy global health burden in the past few decades
This study aimed to investigate the incidence of lymph node metastasis (LNM), explore the role of lymph node dissection (LND), and develop and validate a novel model to predict LNM in patients with HCC, not other specified (NOS)
The LND rate showed no noticeable fluctuation in the last decade, with an annual percent change (APC) of 0.5% (P=0.593)
Summary
Hepatocellular carcinoma (HCC) accounts for approximately 85%-90% of primary liver cancer and has been a heavy global health burden in the past few decades. HCC has several rare pathological subtypes, including fibrolamellar, clear cell, spindle cell, scirrhous and pleomorphic Considering that these subtypes have unique clinicopathological features, the main focus of this study is hepatocellular carcinoma, not otherwise specified (NOS) [7, 8]. Some other studies demonstrated no benefit of LND because of the similar survival, low incidence of LNM, and potentially increased postoperative morbidity [10, 11, 23,24,25]. Another concern is how to accurately evaluate nodal status before surgery, which is important for decision-making of surgical strategies. This study aimed to investigate the incidence of lymph node metastasis (LNM), explore the role of lymph node dissection (LND), and develop and validate a novel model to predict LNM in patients with HCC, not other specified (NOS)
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