학술논문
Predicting Lymph Node Metastasis in Intrahepatic Cholangiocarcinoma.
Document Type
Article
Author
Tsilimigras, Diamantis I.; Sahara, Kota; Paredes, Anghela Z.; Moro, Amika; Mehta, Rittal; Moris, Dimitrios; Guglielmi, Alfredo; Aldrighetti, Luca; Weiss, Matthew; Bauer, Todd W.; Alexandrescu, Sorin; Poultsides, George A.; Maithel, Shishir K.; Marques, Hugo P.; Martel, Guillaume; Pulitano, Carlo; Shen, Feng; Soubrane, Olivier; Koerkamp, Bas Groot; Endo, Itaru
Source
Subject
*LYMPHATIC metastasis
*CHOLANGIOCARCINOMA
*DIAGNOSTIC imaging
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Language
ISSN
1091-255X
Abstract
Background: The objective of the current study was to develop a model to predict the likelihood of occult lymph node metastasis (LNM) prior to resection of intrahepatic cholangiocarcinoma (ICC). Methods: Patients who underwent hepatectomy for ICC between 2000 and 2017 were identified using a multi-institutional database. A novel model incorporating clinical and preoperative imaging data was developed to predict LNM. Results: Among 980 patients who underwent resection of ICC, 190 (19.4%) individuals had at least one LNM identified on final pathology. An enhanced imaging model incorporating clinical and imaging data was developed to predict LNM (https://k-sahara.shinyapps.io/ICC%5fimaging/). The performance of the enhanced imaging model was very good in the training data set (c-index 0.702), as well as the validation data set with bootstrapping resamples (c-index 0.701) and outperformed the preoperative imaging alone (c-index 0.660). The novel model predicted both 5-year overall survival (OS) (low risk 48.4% vs. high risk 18.4%) and 5-year disease-specific survival (DSS) (low risk 51.9% vs. high risk 25.2%, both p < 0.001). When applied among Nx patients, 5-year OS and DSS of low-risk Nx patients was comparable with that of N0 patients, while high-risk Nx patients had similar outcomes to N1 patients (p > 0.05). Conclusion: This tool may represent an opportunity to stratify prognosis of Nx patients and can help inform clinical decision-making prior to resection of ICC. [ABSTRACT FROM AUTHOR]