Abstract
Purpose: This study was conducted to identify factors involved in lymph node metastasis (LNM) and evaluate their role in predicting LNM in clinically lymph node negative (clinical stage I–III) intrahepatic cholangiocarcinoma (ICC). Materials and Methods: We selected 320 patients who were diagnosed with ICC with no apparent clinical LNM (T1–3N0M0). Age, gender, tumor boundary, histological differentiation, tumor size, and carbohydrate antigen 19-9 value were the studied factors. Univariate and multivariate logistic analysis were conducted. Receiver operating characteristics curve analysis was used to test the predicting value of each factor and a test which combined the associated factors was used to predict LNM. Results: LNM was observed in 76 cases (76/320, 23.8%). Univariate and multivariate analysis showed that histological differentiation as well as tumor boundary and tumor size significantly correlated with LNM. The sensitivity and negative predictive value for LNM for the three factors when combined was 96.1 and 95% respectively. This means that 5% of the patients who did not have the risk factors mentioned above developed LNM. Conclusion: This model used the combination of three factors (low-graded histological differentiation, distinct tumor boundary, small tumor size) and they proved to be useful in predicting LNM in ICC with clinically lymph node negative cases. In patients with these criteria, lymph node dissection or lymph node irradiation may be omitted and such cases may also be good candidates for stereotactic body radiotherapy (SBRT).
Highlights
Intrahepatic cholangiocarcinoma (ICC) is a primary malignant tumor arising peripherally to the secondary bifurcation of the left or right hepatic duct
The serum tumor markers such as carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA19-9), and alpha fetoprotein (AFP) were used as diagnostic tools to exclude hepatocellular carcinoma (HCC) or mixed ICC/HCC
Unlike HCC, ICC is commonly associated with lymph node metastasis (LNM)
Summary
Intrahepatic cholangiocarcinoma (ICC) is a primary malignant tumor arising peripherally to the secondary bifurcation of the left or right hepatic duct. Overall resectability rates were 54.6% in a study from Japan (Ikai et al, 2004) and 62% in a study from the United States (Weber et al, 2001) with the 1 and 3 year cumulative survival rates after resection being 49.4–76.6 and 17.3–52.7%, respectively (Fu et al, 2004; Shinohara et al, 2008; Choi et al, 2009; Lang et al, 2009). Adjuvant and definitive radiotherapy may play an important role in the treatment of ICC in the future
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