Pattern and clinical significance of lymph node metastasis from hepatocellular carcinoma.

Abstract

431 Background: We investigated clinical features and prognostic significance as well as the significance of local treatment on LN metastasis from HCC. Methods: The patients diagnosed of HCC with LN metastasis from 2001 to 2019 were evaluated. The HCC was diagnosed using image study and serum tumor marker based on Korean Liver Cancer Study Group guideline. The LN metastasis was diagnosed in accordance to diagnosis criteria in imaging study. The pattern of LN metastasis was evaluated based on imaging study and stratified by 3 groups: group A, regional LN metastasis group, group B, beyond regional intra-abdomen LN metastasis and group C, extra-abdomen LN metastasis group. Results: A total of 852 patients were included. The local treatment of either resection or RT were performed in 265 patients (31.1%). The OS between 3 groups was significantly different; the 1-year OS was 39.8%, 25.5% and 22.2% for group A, B and C, respectively ( p<0.001). The local treatment group presented favorable features involving better liver function, controlled primary cancer and lesser extra-nodal metastasis than no local treatment group (CP-A: 72.5% vs. 54.2%, control of primary cancer: 44.9% vs. 8.7%, extra-nodal metastasis: 85.3% vs. 52.1%, p<0.001). After propensity score matching (PSM), the features were well balanced between the two groups. The OS was significantly better in the local treatment group even after PSM (1-year OS: 51.8% vs. 26.6%, p<0.001). Local treatment showed superior OS in both LN only metastasis and LN plus extra-nodal metastasis (62.3% vs. 31.6% vs. 45.0% vs. 23.4%, p<0.001). In LN only metastasis patients, the dynamics of disease progression showed no difference between two groups ( p=0.651). Conclusions: This study showed that the survival and pattern of failure were significantly different depending on the location of LN metastasis. In patients with regional LN metastasis, active local treatment would enhance the survival of patients.