Preoperative clinicopathological features of patients obtaining survival benefit from lymph node dissection in intrahepatic cholangiocarcinoma resection

doi:10.3877/cma.j.issn.2095-3232.2023.03.006

Abstract

Abstract:

Objective

To investigate the preoperative clinicopathological features of patients who obtained survival benefit from lymph node dissection in resection of intrahepatic cholangiocarcinoma (ICC).

Methods

Clinical data of 415 patients who underwent ICC radical resection in 8 hospitals in China from January 2010 to December 2018 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 225 patients were male and 190 female,aged from 27 to 83 years, with a median age of 59 years. All patients were divided into the dissection and non-dissection groups according to whether intraoperative lymph node dissection was performed. Propensity score matching (PSM) was used to balance the differences between the dissection and non-dissection groups. Survival analysis was performed by Kaplan-Meier method and Log-rank test. Preoperative clinicopathological characteristics of patients obtaining survival benefit in the dissection group were analyzed.

Results

Prior to PSM, 283 patients were allocated in the dissection group and 132 cases in the non-dissection group. After 1∶1 PSM, 228 patients were selected, with 114 cases in each group. The median survival in the dissection and non-dissection groups was 35.4 and 25.0 months, and the overall survival rate in the dissection group was significantly higher than that in the non-dissection group (χ²=5.404, P<0.05). Glisson's capsule invasion,CA19-9>37 kU/L, abnormal neutrophil and lymphocyte count were the preoperative clinicopathological features of ICC patients obtaining survival benefit from lymph node dissection (χ²=9.548, 4.800, 13.715, 13.412; P<0.05).

Conclusions

Lymph node dissection in ICC radical resection can bring survival benefit to patients with hepatic capsule invasion, preoperative CA19-9>37 kU/L, abnormal neutrophil and lymphocyte count.

Key words: Intrahepatic cholangiocarcinoma, Hepatectomy, Lymph node dissection, Survival analysis, Hepatic capsular invasion, CA19-9, Neutrophil, Lymphocyte count

Xiaopeng Yu, Chen Chen, Jialu Chen, Huanjun Tong, Yinghe Qiu, Hong Wu, Tianqiang Song, Yu He, Xianhai Mao, Wenlong Zhai, Zhangjun Cheng, Jingdong Li, Zhimin Geng, Zhaohui Tang. Preoperative clinicopathological features of patients obtaining survival benefit from lymph node dissection in intrahepatic cholangiocarcinoma resection[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2023, 12(03): 278-283.

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参数	PSM前				PSM后
参数	清扫组	未清扫组	统计值	P值	清扫组	未清扫组	统计值	P值
年龄（岁，±s）	57±10	58±10	t=-1.128	0.990	57±9	59±10	t=-1.027	0.959
性别（例，男/女）	143/140	82/50	χ²=4.872	0.027	74/40	68/46	χ²=0.672	0.412
合并结石（例）	78	44	χ²=0.913	0.339	86/28	78/36	χ²=1.390	0.238
合并肝炎（例）	73	46	χ²=3.607	0.058	81/33	77/37	χ²=0.330	0.566
Child-Pugh分级（例，A级/B级）	248/35	119/13	χ²=0.558	0.455	100/14	103/11	χ²=0.404	0.525
ECOG评分（分，0分/1~2分）	191/92	81/51	χ²=1.496	0.221	79/35	71/43	χ²=1.247	0.264
病理分化（例，低分化/中高分化）	154/129	90/42	χ²=7.040	0.008	74/40	80/34	χ²=0.720	0.396
形态学分类（例，肿块型/非肿块型）	187/96	87/45	χ²=0.001	0.973	78/36	75/39	χ²=0.179	0.672
血管侵犯（例）	81	17	χ²=12.368	<0.001	94/20	99/15	χ²=0.844	0.358
肝被膜侵犯（例）	145	44	χ²=11.633	0.001	76/38	75/39	χ²=0.020	0.889
肿瘤直径[cm，M（Q₁，Q₃）]	5.1(3.0，7.4)	4.4(3.0，7.0)	Z=2.537	0.011	5.0(3.0，7.1)	4.5(3.0，7.0)	Z=1.188	0.235
AFP [μg/L，M（Q₁，Q₃）]	3.2(2.2，6.1)	3.4(2.2，8.5)	Z=-0.792	0.428	3.3(2.3，6.7)	3.3(2.2，9.1)	Z=-0.171	0.864
CEA [μg/L，M（Q₁，Q₃）]	3.1(1.7，7.0)	2.6(1.4，4.5)	Z=2.120	0.340	2.9(1.7，5.3)	2.6(1.4，4.5)	Z=1.012	0.312
CA19-9 [kU/L，M（Q₁，Q₃）]	81(19，656)	50(14，318)	Z=2.021	0.043	44(13，385)	58(16，349)	Z=-0.508	0.611
TB [μmol/L，M（Q₁，Q₃）]	13.6(10.2，19.0)	13.3(10.8，19.7)	Z=0.256	0.798	13.9(10.3，21.5)	13.3(10.8，19.6)	Z=0.475	0.635

参数	PSM前				PSM后
参数	清扫组	未清扫组	统计值	P值	清扫组	未清扫组	统计值	P值
年龄（岁，±s）	57±10	58±10	t=-1.128	0.990	57±9	59±10	t=-1.027	0.959
性别（例，男/女）	143/140	82/50	χ²=4.872	0.027	74/40	68/46	χ²=0.672	0.412
合并结石（例）	78	44	χ²=0.913	0.339	86/28	78/36	χ²=1.390	0.238
合并肝炎（例）	73	46	χ²=3.607	0.058	81/33	77/37	χ²=0.330	0.566
Child-Pugh分级（例，A级/B级）	248/35	119/13	χ²=0.558	0.455	100/14	103/11	χ²=0.404	0.525
ECOG评分（分，0分/1~2分）	191/92	81/51	χ²=1.496	0.221	79/35	71/43	χ²=1.247	0.264
病理分化（例，低分化/中高分化）	154/129	90/42	χ²=7.040	0.008	74/40	80/34	χ²=0.720	0.396
形态学分类（例，肿块型/非肿块型）	187/96	87/45	χ²=0.001	0.973	78/36	75/39	χ²=0.179	0.672
血管侵犯（例）	81	17	χ²=12.368	<0.001	94/20	99/15	χ²=0.844	0.358
肝被膜侵犯（例）	145	44	χ²=11.633	0.001	76/38	75/39	χ²=0.020	0.889
肿瘤直径[cm，M（Q₁，Q₃）]	5.1(3.0，7.4)	4.4(3.0，7.0)	Z=2.537	0.011	5.0(3.0，7.1)	4.5(3.0，7.0)	Z=1.188	0.235
AFP [μg/L，M（Q₁，Q₃）]	3.2(2.2，6.1)	3.4(2.2，8.5)	Z=-0.792	0.428	3.3(2.3，6.7)	3.3(2.2，9.1)	Z=-0.171	0.864
CEA [μg/L，M（Q₁，Q₃）]	3.1(1.7，7.0)	2.6(1.4，4.5)	Z=2.120	0.340	2.9(1.7，5.3)	2.6(1.4，4.5)	Z=1.012	0.312
CA19-9 [kU/L，M（Q₁，Q₃）]	81(19，656)	50(14，318)	Z=2.021	0.043	44(13，385)	58(16，349)	Z=-0.508	0.611
TB [μmol/L，M（Q₁，Q₃）]	13.6(10.2，19.0)	13.3(10.8，19.7)	Z=0.256	0.798	13.9(10.3，21.5)	13.3(10.8，19.6)	Z=0.475	0.635

参数	中位生存期（月）		χ ²值	P值
参数	清扫组	未清扫组	χ ²值	P值
年龄≥60岁	30.2	21.0	1.579	0.209
性别女	29.7	38.0	0.057	0.811
合并结石	18.5	20.0	0.081	0.777
合并肝炎	35.4	26.0	0.626	0.429
AFP≥7.0 μg/L	29.7	24.0	0.882	0.348
CEA≥5.0 μg/L	29.0	15.0	2.060	0.151
CA19-9≥37 kU/L	35.4	20.0	4.800	0.028
TB≥17.1 μmol/L	29.0	16.0	0.287	0.592
Child-Pugh分级B级	22.0	16.0	0.008	0.928
血管侵犯	29.7	28.0	0.001	0.979
肝被膜侵犯	57.1	13.5	9.548	0.002
肿瘤直径≥5.0 cm	35.4	18.0	3.232	0.072
非肿块型	38.0	20.1	1.636	0.201
存在子灶	39.0	15.0	2.179	0.140
WBC<4.0×10⁹/L或>10.0×10⁹/L	28.0	24.0	0.478	0.489
中性粒细胞<1.8×10⁹/L或>6.3×10⁹/L	57.1	12.1	13.715	<0.001
淋巴细胞<0.8×10⁹/L或>3.5×10⁹/L	57.1	16.0	13.412	<0.001
ALT>40 U/L	29.0	20.1	0.160	0.689
PT<11 s或>13 s	38.0	25.0	3.089	0.079

参数	中位生存期（月）		χ ²值	P值
参数	清扫组	未清扫组	χ ²值	P值
年龄≥60岁	30.2	21.0	1.579	0.209
性别女	29.7	38.0	0.057	0.811
合并结石	18.5	20.0	0.081	0.777
合并肝炎	35.4	26.0	0.626	0.429
AFP≥7.0 μg/L	29.7	24.0	0.882	0.348
CEA≥5.0 μg/L	29.0	15.0	2.060	0.151
CA19-9≥37 kU/L	35.4	20.0	4.800	0.028
TB≥17.1 μmol/L	29.0	16.0	0.287	0.592
Child-Pugh分级B级	22.0	16.0	0.008	0.928
血管侵犯	29.7	28.0	0.001	0.979
肝被膜侵犯	57.1	13.5	9.548	0.002
肿瘤直径≥5.0 cm	35.4	18.0	3.232	0.072
非肿块型	38.0	20.1	1.636	0.201
存在子灶	39.0	15.0	2.179	0.140
WBC<4.0×10⁹/L或>10.0×10⁹/L	28.0	24.0	0.478	0.489
中性粒细胞<1.8×10⁹/L或>6.3×10⁹/L	57.1	12.1	13.715	<0.001
淋巴细胞<0.8×10⁹/L或>3.5×10⁹/L	57.1	16.0	13.412	<0.001
ALT>40 U/L	29.0	20.1	0.160	0.689
PT<11 s或>13 s	38.0	25.0	3.089	0.079

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