Sean P Martin1, Samantha Ruff2, Laurence P Diggs3, Justin Drake4, Reed I Ayabe5, Zachary J Brown6, Michael M Wach7, Seth M Steinberg8, Jeremy L Davis9, Jonathan M Hernandez10. 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.
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.
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