| Background:Intrahepatic Cholangiocellular Carcinoma is a malignant tumor originating from bile duct epithelial cells.Compared with primary hepatocellular carcinoma,the incidence of ICC is lower,but it has been on the rise in recent years.Surgical treatment is the preferred treatment for ICC.ICC is easily metastasized through the lymphatic system.In the clinical treatment of ICC,whether preoperative and intraoperative examination of patients with and without lymph node metastasis can benefit from lymph node dissection,the scope and the number of intraoperative lymph node dissection as well as other clinical problems such as post-operative positive lymph nodes for patients’ prognostic prediction have attracted more and more attention from clinicians.Distal cholangiocarcinoma,pancreatic cancer,and gallbladder cancer,the lymph node staging is further stratified according to the number of positive lymph nodes after surgery,which can well predict the survival of patients after surgery,guide postoperative treatment,Whether ICC patients can also carry out accurate N staging according to this staging standard needs further discussion.Objective:It is to explore the effects of lymph node dissection on postoperative survival of Intrahepatic Cholangiocellular Carcinoma patients with negative and positive lymph nodes as well as the number of positive lymph nodes for patients’ postoperative survival prediction.Methods:1.The clinical data of 161 cases of ICC patients who underwent radical surgical resection in our hospital from February 2013 to October 2019 were retrospectively analyzed.According to different grouping criteria,they were divided into different groups: 1.According to whether lymph nodes were dissected or not,161 cases of ICC patients were divided into undissected group(n=68)and dissected group(n=93).2.According to the lymph node metastasis,93 ICC patients in the lymph node dissection group were divided into the following two ones: lymph node-negative one and lymph node-positive one which were 40 and 53 respectively.3.The patients above mentioned were also divided into the following three groups based on the number of postoperative positive lymph nodes: N0(lymph nodes were all negative),N1(lymph nodes were all positive and the number was below 3)and N2(lymph nodes were all positive and the number was greater or equal to 3)which were 40,21 and 32 respectively.4.According to the number of lymph nodes dissected during operation,the patients above mentioned were divided into the two groups: L(the number of lymph nodes dissected during operation﹤6)and M(the number of lymph nodes dissected during operation≥6)which were 38 and 55 respectively.5.In term of the L group(the number of lymph nodes dissected during operation﹤6),the patients in it were divided into the following three groups: LN0(negative lymph nodes),LN1(lymph nodes were positive and the number of them was below 3)and LN2(lymph nodes were positive and the number of them was greater than or equal to3)which were 20,10 and 8 respectively.Similarly,the patients in M group above mentioned were also divided into MN0(negative lymph nodes),MN1(lymph nodes were positive and the number of them was below 3)and MN2(lymph nodes were positive and the number of them was greater than or equal to3)which were 20,11 and24 respectively.Then the differences between different groups were made in the postoperative survival rate and the survival curves constructed with the method of Kaplan-Meier;the independent factors affecting the survival and prognosis of patients were screened through univariate and multivariate Cox regression analysis.Results:1.In term of the ICC patients in lymph node undissected group(n=68),the median survival time was 10 months while those with the survival time of one year or three years respectively accounted for 34.2% or 19.1%.In term of the ICC patients in lymph node dissected group(n=93),the median survival time was just one month more than that of the ICC patients in lymph node undissected group while thereinto,those with the survival time of one year or three years accounted for 40.4% or 20.4%respectively;through comparison between the two groups above mentioned,it was found there were no significant differences in the median survival time and the postoperative survival rate(P > 0.05).2.In term of the ICC patients with negative lymph nodes(n=40),the median survival time was 18 months while those with the survival time of one year or three years accounted for 53.4% or 32.5% respectively;in term of the ICC patients with positive lymph nodes(n=53),the median survival time was half of that of the patients above mentioned while those with the survival time of one year or three years accounted for 30.3% or 11.4% respectively.There was statistically significant difference in overall survival rate among the three groups of undissected lymph nodes,positive lymph nodes and negative lymph nodes(P<0.05).Through comparison between the three groups: group of undissected lymph nodes,group of positive lymph nodes and group of negative lymph nodes,it is found that the last one is significantly superior to the former two groups in postoperative median survival time and postoperative survival rate(P<0.05)while there were no significant differences between the former two groups in the median survival time and the survival rate(P> 0.05).3.The median survival time of 40 ICC patients in N0 group(lymph node negative)was 18 months,and the 1-and 3-year survival rates were 53.4% and 32.5%,respectively.In term of 21 ICC patients in the group N1 above mentioned,the median survival time was 12 months while those with the survival time of one year or three years were 46.7% or 17.5% respectively;in term of 32 ICC patients in the group N2 above mentioned,the median survival time was 6 months while those with the survival time of one year or three years accounted for 19.6% or 0% respectively.There was statistical significance in overall survival rate among the three groups(P <0.05).The results of pairwise comparison among the three groups showed that the postoperative survival of the N0 group was better than that of the N1 and N2 groups,with statistically significant differences(P < 0.05).The postoperative survival of N1 group was better than that of N2 group,different with statistical significance(P< 0.05).4.In term of the 38 ICC patients in the L groups above mentioned,the median survival time was 11 months while those with the postoperative survival time of one year or three years accounted for 32.3% or 16.4% respectively;in term of the 55 ICC patients in the M groups above mentioned,the median survival time was 12 months while those with the postoperative survival time of one year or three years accounted for 45.7% or 23.1% respectively;for the three groups: L,M and the undissected group,there were no statistical significance in postoperative survival rate(P>0.05);there were also no significant differences between them in both median survival time and postoperative survival rate(P>0.05).5.Overall survival rate of MN0 group,MN1 group and MN2 group was significantly different among the three groups(P < 0.05).The results of pairwise comparison among the three groups showed that the postoperative survival time and survival rate of MN0 group were significantly better than that of MN1 group and MN2 group(P < 0.05),and the postoperative survival rate of MN1 group was better than that of MN2 group,and the difference in postoperative survival rate was statistically significant(P < 0.05).6.the single factor analysis showed that preoperative CA19-9 levels,tumor location,tumor size,tumor number,lymph node metastasis,the number of positive lymph nodes,margin state related to the prognosis of patients(P < 0.05),Multi-factor analysis showed that tumor location,tumor size,tumor number,lymph node metastasis,the number of positive lymph nodes,margin state are independent risk factors affect the prognosis of patients(P < 0.05).Conclusion:1.Lymph node dissection does not benefit patients with positive lymph nodes,while lymph node dissection can significantly improve the prognosis of patients with negative ICC,prolong postoperative survival time and improve postoperative survival rate.2.The difference in the number of postoperative positive lymph nodes has a significant impact on postoperative survival of patients.The postoperative survival of patients with the number of postoperative positive lymph nodes ≥3 is worse than that of patients with the number of postoperative positive lymph nodes < 3 and patients without lymph node metastasis,and there is a significant stratification of postoperative survival between different groups.3.When the number of intraoperative lymph nodes dissected is ≥6,it can more accurately reflect the regional lymph node metastasis and predict the prognosis of ICC patients.4.In addition to tumor diameter,Tumor location,tumor number,lymph node metastasis and surgical margin status were also the independent risk factors affecting the prognosis of patients with ICC as well as the number of post-operative positive lymph nodes. |
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