Z Gastroenterol 2019; 57(09): e255
DOI: 10.1055/s-0039-1695289
Leber und Galle
CCC und NET: Donnerstag, 03. Oktober 2019, 12:50 – 14:26, Studio Terrasse 2.1 A
Georg Thieme Verlag KG Stuttgart · New York

Lymph Node Involvement in cholangiocellular and papillary carcinomas: A Survival Analysis

SA Safi
1   Universitätsklinikum Düsseldorf, Abteilung für Allgemein-, Viszeral- und Kinderchirurgie, Düsseldorf, Deutschland
,
A Rehders
1   Universitätsklinikum Düsseldorf, Abteilung für Allgemein-, Viszeral- und Kinderchirurgie, Düsseldorf, Deutschland
,
WT Knoefel
1   Universitätsklinikum Düsseldorf, Abteilung für Allgemein-, Viszeral- und Kinderchirurgie, Düsseldorf, Deutschland
,
A Krieg
1   Universitätsklinikum Düsseldorf, Abteilung für Allgemein-, Viszeral- und Kinderchirurgie, Düsseldorf, Deutschland
› Author Affiliations
Further Information

Publication History

Publication Date:
13 August 2019 (online)

Also available at
 

Background:

Survival after surgery for cholangiocellular carcinomas (CCC) as well as for papillary carcinoma (PC) remains poor. Yet, no international guidelines are avaiable. PCs account for only approximately 6% of all periampullary malignancies. The 5-year-survival rate is about 30 – 60%. CCCs of the biliary confluence (hCCC) account for up to 60% of all cases. 30% originate in the lower bile duct (dCCC), and approximately 10% arise as an intrahepatic mass (iCCC). The 5-year survival rate for all CCCs is about 40%. While some studies suggest that positive nodal status (N1) is one of the most important prognostic factors after margin-negative resection, other data imply that nodal disease is not associated with survival outcome. Thus, the aim of this study was to identify prognostic variables in CCC and PC and to investigate the prognostic value of lymph node (LN) involvement, LN ratio (LNR) and log odds of positive LNs (LODDS).

Method:

179 patients who were undergoing surgery for CCCs and PCs between 2003 and 2019 were analyzed. Reports were assessed to gather data on nodal status. Both LNR (ratio of positive LN to examined LN) and LODDS (log (positive LN+0.5)/(total LN+0.5)) were calculated respectively. Individual cut off levels and subgroups were set both for LNR and LODDS by median and quartiles respectively. OS and DFS was determined for all patients by the Kaplan-Meier method and Cox regression.

Results:

Of the 179 patients, 41 and 42 patients underwent partial pancreaticoduodenectomy (pPD) for dCCCs and PCs respectively; while 66 and 30 patients received liver resection for iCCCs and kCCCs respectively. 23, 23, 14 and 17 patients showed LN infiltration (N1) in PCs dCCCs, kCCCs and iCCCs. In our cohort, on uni- and multivariate Analysis, N1 was not associated with poor prognosis (p = NS). Interestingly, on further analysis, LNR and LODDS were significant prognostic factors in OS and DFS.

Conclusion:

While LN infiltration is of no prognostic value, interestingly, LN ratio and LODDS are prognostic factors independent on tumor location. Therefore, LNR and LODDS should be included in pathologic reporting and taken into consideration for prognosis assessment. Further multicenter studies are required to validate the results in a larger cohort.