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Vascularity of Intrahepatic Cholangiocarcinoma on Computed Tomography is Predictive of Lymph Node Metastasis

  • Hepatobiliary Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The indications for lymph node dissection (LND) for intrahepatic cholangiocarcinoma (ICC) are controversial.

Methods

Seventy patients with mass-forming dominant ICC underwent hepatectomy with systematic LND or lymph node sampling between 2003 and 2013. We defined the computed tomography (CT) ratio as the CT value (Hounsfield units) of the tumor divided by the CT value (Hounsfield units) of the liver parenchyma in the late arterial phase, and investigated the indications for LND with hepatectomy for ICC.

Results

A multivariate analysis identified lymph node metastasis (LNM; n = 19, p = 0.012) and perineural invasion (p = 0.017) as independent predictors of survival. The median survival time and 5-year survival rate in patients exhibiting LNM were 31.1 months and 16.0 %, respectively. In a subgroup analysis of patients without LNM, overall survival was comparable between patients treated with LND and those treated without LND (p = 0.801). A multivariate analysis of the preoperatively measurable parameters revealed that a CT ratio <0.88 and macroscopic periductal infiltration were independently associated with LNM. We developed a score predicting LNM of mass-forming dominant ICC (LMIC score), assigning 1 point for each of these risk factors. The percentages of patients with LNM with an LMIC score of 0, 1, or 2 points were 0, 35, and 58 %, respectively.

Conclusions

The vascularity of ICC is associated with important prognostic factors, LNM, and perineural invasion. LN dissection would be conducted in patients with an LMIC score of one or two points but can be omitted in patients with an LMIC score of zero.

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DISCLOSURE

Yusuke Yamamoto, Mehmet Akif Türkoğlu, Takeshi Aramaki, Teiichi Sugiura, Yukiyasu Okamura, Takaaki Ito, Ryo Ashida, Sunao Uemura, Takashi Miyata, Yoshiyasu Kato, Yuko Kakuta, Yasuni Nakanuma, and Katsuhiko Uesaka declare no conflicts of interest in association with this study.

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Authors and Affiliations

  1. Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, Shizuoka, Japan

    Yusuke Yamamoto MD, Mehmet Akif Türkoğlu MD, Teiichi Sugiura MD, PhD, Yukiyasu Okamura MD, PhD, Takaaki Ito MD, Ryo Ashida MD, Sunao Uemura MD, Takashi Miyata MD, Yoshiyasu Kato MD & Katsuhiko Uesaka MD, PhD

  2. Division of Radiology, Shizuoka Cancer Center, Shizuoka, Japan

    Takeshi Aramaki MD, PhD

  3. Division of Pathology, Shizuoka Cancer Center, Shizuoka, Japan

    Yuko Kakuta MD, PhD & Yasuni Nakanuma MD, PhD

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  1. Yusuke Yamamoto MD
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  2. Mehmet Akif Türkoğlu MD
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  3. Takeshi Aramaki MD, PhD
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  11. Yuko Kakuta MD, PhD
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  12. Yasuni Nakanuma MD, PhD
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  13. Katsuhiko Uesaka MD, PhD
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Correspondence to Yusuke Yamamoto MD.

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Yamamoto, Y., Türkoğlu, M.A., Aramaki, T. et al. Vascularity of Intrahepatic Cholangiocarcinoma on Computed Tomography is Predictive of Lymph Node Metastasis. Ann Surg Oncol 23 (Suppl 4), 485–493 (2016). https://doi.org/10.1245/s10434-016-5382-1

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  • DOI: https://doi.org/10.1245/s10434-016-5382-1

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