区域淋巴结清扫对肝内胆管癌根治术后复发模式的影响

Impact of regional lymph node dissection on the recurrence pattern of intrahepatic cholangiocarcinoma after radical resection

目的目前肝内胆管癌(ICC)是否常规进行区域淋巴结清扫(LND)仍存争议。本研究旨在探究LND对ICC根治术后复发模式的影响。方法回顾性研究中山大学附属第一医院2010年1月至2021年5月165例ICC并行LND的患者,收集患者的一般资料、血液学检查指标、术前影像学检查资料(CT、MRI或PET-CT)和手术记录,分析术前影像学诊断淋巴结转移的价值以及LND对ICC术后不同复发模式的影响。结果术前影像学诊断ICC淋巴结转移的敏感度为61.0%,特异度为58.9%,准确性为59.4%。124例cN0并行LND患者中,清扫个数≥6组阳性淋巴结比例占60.8%(31/51),显著高于清扫个数<6组的27.4%(20/73),差异有统计学意义(χ^(2)=13.82,P<0.001);随访期间,中位无复发生存时间为9.3个月(1~49.5个月),清扫个数≥6组和清扫个数<6组分别复发26、40例,清扫个数≥6组患者的局部淋巴结复发率更低,两组复发模式差异有统计学意义(P=0.037)。结论术前影像学诊断ICC淋巴结转移价值有限,应常规进行区域LND,清扫数量6个以上有助于改善淋巴结分期和减少cN0患者根治术后局部淋巴结复发。

Objective Routine regional lymph node dissection(LND)in the resection of intrahepatic cholangiocarcinoma(ICC)is still controversial.This study aims to investigate the impact of LND on the recurrence pattern of ICC after radical resection.Methods A total of 165 ICC patients from January 2010 to May 2021 in the First Affiliated Hospital of Sun Yat-sen University were retrospectively selected as the research subjects.The general information,hematological examination indexes,preoperative imaging data(CT,MRI or PET-CT)and operation records of patients were collected to analyze the impact of LND on the recurrence pattern of ICC after radical resection.Results The sensitivity,specificity and accuracy of preoperative imaging in diagnosing lymph node metastasis were 61.0%,58.9%and 59.4%,respectively.Among the 124 patients with cN0 complicated with LND,the proportion of positive lymph nodes in the group with dissection≥6 accounted for 60.8%(31/51),which was significantly higher than 27.4%(20/73)in the group with dissection<6(χ^(2)=13.82,P<0.001).During the follow-up period,the median recurrence free survival time was 9.3(1-49.5)months.26 cases recurred in the group with dissection≥6 and 40 cases in the group dissection<6,respectively.There was significant difference in the recurrence pattern between the two groups,and the recurrence rate of regional lymph nodes in the group with dissection≥6 was lower(P=0.037).Conclusions The value of preoperative imaging in diagnosing lymph node metastasis in ICC is limited,and regional LND should be performed routinely.Dissection of more than 6 lymph nodes can help to improve lymph node staging and reduce local lymph node recurrence in patients with cN0 after radical resection.