The Impact Of Lymph Node Dissection On The Survival Of Intrahepatic Cholangiocarcinoma Patient Survival

Objective: to evaluate whether lymph node dissection can improve the prognosis of intrahepatic Cholangiocarcinoma(ICC)and to explore the risk factors related to the prognosis.Methods: Pubmed,Em Base,Web of Science,Wanfang data,CNKI,and database were searched by computer from January 1,2010 to September 1,2020.The literature requests to divide intrahepatic Cholangiocarcinoma into two groups: LND(+)and LND(-),and compare the difference of prognosis between the two groups.The literature was selected independently by two researchers,and the related data were Meta-analyzed by Revman 5.3 software after analyzing the Kaplan-Meier survival curve with NOS scale and Engauge-Digitizer software.Results: 10 papers met the requirements of literature extraction,and 10 papers were included in different Meta-analysis groups according to the data provided.A total of1507 cases were included,including 702 with LND(+)and 805 LND(-).Meta-analysis showed Overall Survival(OS)versus LND(+)versus LND(-).Risk rate(HR =0.89,95% CI: 0.61-1.28;p = 0.53).The risk rate was less than 1,suggesting that lymph node dissection for intrahepatic cholangiocarcinoma was a protective factor for overall survival.P > 0.05,there was no statistical difference.Disease-Free Survival(DFS):(HR= 0.76,95% CI: 0.47-1.28 = 3;P = 0.27).The risk was less than 1,suggesting that lymph node dissection for intrahepatic cholangiocarcinoma was a protective factor for DFS.P > 0.05,there was no statistical difference.The related prognostic risk factors are lymph node metastasis(LNM):(HR = 3.01,95% CI: 2.04-4.45;p < 0.0001).It is concluded that lymph node metastasis is a risk factor for prognosis of intrahepatic Cholangiocarcinoma.The statistical difference was significant(p < 0.05).Vascular infiltration:(HR = 1.57,95% CI: 1.14-2.15;p = 0.005).It is concluded that vascular invasion is a risk factor for prognosis of intrahepatic Cholangiocarcinoma.P < 0.05,the statistical difference was significant.Bile Duct Invasion:(HR = 1.66,95% CI: 1.26-2.20;p < 0.0004).It is concluded that peribiliary infiltration is a risk factor for the prognosis of intrahepatic Cholangiocarcinoma.P < 0.05,the statistical difference was significant.Tumor Size:(HR = 1.51,95% CI: 1.23-1.86;p < 0.0001).It is concluded that tumor larger than 5 cm is a risk factor for the prognosis of intrahepatic Cholangiocarcinoma.P< 0.05,the statistical difference was significant.Tumor Number: HR = 1.51,95% CI:1.21-1.89;p < 0.0003.It is concluded that the multiple tumors are a risk factor for the prognosis of intrahepatic Cholangiocarcinoma.The statistical difference was significant(p < 0.05).Conclusion: In intrahepatic Cholangiocarcinoma,lymphadenectomy is a protective factor for the overall Survival(OS)and Disease-Free Survival(DFS).Lymph node metastasis(LNM),Vascular invasion,Bile duct invasion,Tumor Size and Tumor Number are prognostic risk factors.For intrahepatic Cholangiocarcinoma,lymph node dissection should be performed routinely.