Prognostic impact of lymph node metastasis in distal cholangiocarcinoma

BackgroundThe aim of the study was to investigate the prognostic impact of lymph node metastasis in cholangiocarcinoma using three different classifications. MethodsPatients who underwent pancreaticoduodenectomy for distal cholangiocarcinoma in 24 hospitals in Japan between 2001 and 2010 were included. Survival was calculated by means of the Kaplan-Meier method and differences between subgroups were assessed with the log rank test. The Cox proportional hazards model was used to identify independent predictors of survival. (2) scores were calculated to determine the cut-off value of the number of involved nodes, lymph node ratio (LNR) and total lymph node count (TLNC) for discriminating survival. ResultsSome 370 patients were included. The median (range) TLNC was 19 (3-59). Nodal metastasis occurred in 157 patients (424 per cent); the median (range) number of involved nodes and LNR were 2 (1-19) and 011 (002-080) respectively. Four or more involved nodes was associated with a significantly shorter median survival (13 versus 22years; P = 0001), as was a LNR of at least 017 (14 versus 23years; P = 0002). Involvement of nodes along the common hepatic artery, present in 21 patients (134 per cent), was also associated with a shorter survival (median 13 versus 21years; P = 0046). Multivariable analysis among 157 node-positive patients identified the number of involved nodes as an independent prognostic factor (risk ratio 187; P = 0002). ConclusionThe number of involved nodes was a strong predictor of survival in patients with distal cholangiocarcinoma. Number of involved nodes predicts survival after surgery