Predictive Value Of Imaging Findings Of Primary Intrahepatic Cholangiocarcinoma On Lymph Node Metastasis

Background:To compare the difference of computed tomography(CT)features between intrahepatic cholangiocarcinomas(ICCs)with and without lymph node metastasis(LNM)and to construct a nomogram based on those features to predict LNM and overall survival of ICC patients preoperatively.Methods:Clinicopathological and contrast-enhanced CT features of 63 ICC patients were retrospectively analyzed and compared between ICCs with(n = 25)and without LNM(n = 38).Multivariate logistic regression analysis was performed to construct a nomogram to predict LNM preoperatively.Survival curves were drawn with Kaplan-Meier method and survival difference was compared between ICC patients with and without LNM.Results:ICCs with and without LNM differed significantly in clinical symptoms,tumor location,morphologic classification,arterial phase(AP)enhancement degree-mean,AP enhancement degree-max,portal venous phase enhancement degree-max,equilibrium-phase(EP)enhancement ratio,EP CT value-max and EP CT value-max/liver(all p<0.05).A nomogram based on morphologic classification,EP CT value-max and EP enhancement ratio was constructed to predict LNM with an area under curve(AUC)of 0.814(p<0.001).ICC patients with LNM risk>0.20 based on nomogram(n = 47)showed a significantly poorer overall survival than those with LNM risk<0.20(n = 16)(39.5 ± 5.2 vs.51.1 ± 4.7 months,p-log rank = 0.023,p-breslow =0.019,p-tarone ware = 0.020).Conclusion:Preoperative CT features of ICCs differed significantly between those with and without LNM.Nomogram based on those features could predict LNM and overall survival even better than N stage.