Does resection improve overall survival for intrahepatic cholangiocarcinoma with nodal metastases?

Patrick J Sweigert; Emanuel Eguia; Haroon Janjua; Sean P Nassoiy; Lawrence M Knab; Gerard Abood; Paul C Kuo; Marshall S Baker

doi:10.1016/j.sopen.2020.04.003

Does resection improve overall survival for intrahepatic cholangiocarcinoma with nodal metastases?

Surg Open Sci. 2020 May 16;2(3):107-112. doi: 10.1016/j.sopen.2020.04.003. eCollection 2020 Jul.

Authors

Patrick J Sweigert¹, Emanuel Eguia¹, Haroon Janjua², Sean P Nassoiy¹, Lawrence M Knab¹, Gerard Abood¹, Paul C Kuo², Marshall S Baker¹

Affiliations

¹ Loyola University Medical Center, Department of Surgery, 2160 S First Ave, Maywood, IL 60153.
² University of South Florida, Department of Surgery, 2 Tampa General Circle, Tampa, FL 33606.

Abstract

Background: The potential benefit of surgical resection of intrahepatic cholangiocarcinoma in patients with locoregionally advanced disease has not been definitively determined.

Methods: The National Cancer Database was queried to identify patients with clinical evidence of node-positive intrahepatic cholangiocarcinoma. Resected patients were stratified by margin status and lymph node ratio (nodes positive to nodes harvested). Risk of death was determined using Cox regression models and Kaplan-Meier survival functions.

Results: A total of 1,425 patients with T(any)N1M0 intrahepatic cholangiocarcinoma were identified. Two hundred twelve (14.9%) underwent surgical resection. On multivariable Cox regression, R0 resection afforded a survival benefit regardless of lymph node ratio (lymph node ratio > 0.5: hazard ratio 0.466, 95% confidence interval 0.304-0.715; lymph node ratio ≤ 0.5: hazard ratio 0.444, 95% confidence interval 0.322-0.611), whereas a survival benefit was only seen in R1 patients with lymph node ratio ≤ 0.5 (hazard ratio 0.470, 95% confidence interval 0.316-0.701). On Kaplan-Meier, median survival was 11.6 months with chemotherapy, 15.7 months with R0 resection in lymph node ratio > 0.5, and 22.2 months with R0 resection in lymph node ratio ≤ 0.5 (P < .001).

Discussion: Margin negative resection is associated with a risk-adjusted survival benefit for patients with clinically N1 intrahepatic cholangiocarcinoma regardless of the degree of regional lymph node involvement.