Tumor grade and sex should influence the utilization of portal lymphadenectomy for early stage intrahepatic cholangiocarcinoma

Sean P Martin; Samantha Ruff; Laurence P Diggs; Justin Drake; Reed I Ayabe; Zachary J Brown; Michael M Wach; Seth M Steinberg; Jeremy L Davis; Jonathan M Hernandez

doi:10.1016/j.hpb.2018.07.026

Tumor grade and sex should influence the utilization of portal lymphadenectomy for early stage intrahepatic cholangiocarcinoma

HPB (Oxford). 2019 Apr;21(4):419-424. doi: 10.1016/j.hpb.2018.07.026. Epub 2018 Aug 20.

Authors

Affiliations

¹ Thoracic and Oncologic Surgery Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Building 10, Room 4-3942, Bethesda, MD, 20892, USA. Electronic address: sean.martin@nih.gov.
² Thoracic and Oncologic Surgery Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Building 10, Room 4-3942, Bethesda, MD, 20892, USA. Electronic address: samantha.ruff@nih.gov.
³ Thoracic and Oncologic Surgery Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Building 10, Room 4-3942, Bethesda, MD, 20892, USA. Electronic address: laurence.diggs@nih.gov.
⁴ Thoracic and Oncologic Surgery Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Building 10, Room 4-3942, Bethesda, MD, 20892, USA. Electronic address: justin.drake@nih.gov.
⁵ Thoracic and Oncologic Surgery Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Building 10, Room 4-3942, Bethesda, MD, 20892, USA. Electronic address: reed.ayabe@nih.gov.
⁶ Thoracic and Oncologic Surgery Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Building 10, Room 4-3942, Bethesda, MD, 20892, USA. Electronic address: zachary.brown@nih.gov.
⁷ Thoracic and Oncologic Surgery Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Building 10, Room 4-3942, Bethesda, MD, 20892, USA. Electronic address: michael.wach@nih.gov.
⁸ Biostatistics and Data Management Section, Center for Cancer Research, National Cancer Institute, National Institutes of Health, 9609 Medical Center Drive, Room 2W334, Rockville, MD, 20850, USA. Electronic address: steinbes@mail.nih.gov.
⁹ Thoracic and Oncologic Surgery Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Building 10, Room 4-3942, Bethesda, MD, 20892, USA. Electronic address: jeremy.davis@nih.gov.
¹⁰ Thoracic and Oncologic Surgery Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Building 10, Room 4-3942, Bethesda, MD, 20892, USA. Electronic address: jonathan.hernandez@nih.gov.

Abstract

Background: Portal lymphadenectomy for intrahepatic cholangiocarcinoma (ICC) is encouraged for staging purposes, though it is under-utilized for clinically early-stage tumors. We sought to determine if any factor knowable prior to resection influences rates of portal lymph node metastases.

Methods: The Surveillance, Epidemiology, and End Results (SEER) Program (1973-2014) database was queried to identify patients with T1/T2 ICC undergoing resection. Patients were stratified by lymph node (LN) status. Patients deemed LN negative required examination of six or more LNs (AJCC guidelines).

Results: One-hundred and fifty-two patients were included in the analysis (LN negative: 38, LN positive: 114). Patients with LN negative cancers experienced prolonged overall survival as compared to patients with positive LNs (median 77 months vs 19 months, respectively p < 0.001). Twelve patients had well-differentiated tumors (G1), 92 patients had moderately-differentiated tumors (G2) and 58 patients had poorly-differentiated tumors (G3). Tumor grade (OR 3.9, CI 1.1-13.7, p = 0.031) and male sex (OR 2.6, CI 1.1-6.1, p = 0.022) were associated with positive LNs on multivariable logistic regression analysis.

Conclusion: Intermediate/High grade and male sex are associated with high rates of lymph node metastasis for patients with early-stage ICC, which portends abbreviated overall survival.

MeSH terms

Aged
Aged, 80 and over
Bile Duct Neoplasms / pathology*
Bile Duct Neoplasms / surgery*
Cholangiocarcinoma / pathology*
Cholangiocarcinoma / surgery*
Female
Humans
Lymph Node Excision / methods*
Male
Middle Aged
Neoplasm Grading
Neoplasm Staging
Retrospective Studies
SEER Program
Sex Factors
Survival Analysis

Grants and funding

ZIA BC011861/ImNIH/Intramural NIH HHS/United States