Preoperative criterion identifying a low-risk group for lymph node
metastasis in intrahepatic cholangiocarcinoma
Published online: 22 May 2018
© 2018 Japanese Society of Hepato-Biliary-Pancreatic Surgery
Background Imaging study cannot identify patients with
potential low-risk for lymph node (LN) metastasis in
intrahepatic cholangiocarcinoma (ICC). The purpose of
this study was to identify a low-risk group for LN
metastasis in ICC using preoperatively available factors.
Methods Data from 127 consecutive patients, who
underwent curative intent surgery for ICC at Kyoto
University Hospital and Kitano Hospital between 2002
and 2016, were retrospectively analyzed. By using only
preoperative data, multiple linear regression model for
predicting LN metastasis was developed.
Results Forty-three patients exhibited LN metastasis
(33.9%). Serum CA19-9 levels ≥37 IU/ml, ICC with hilar
invasion, and LN swelling were identiﬁed as independent
preoperative predictors of LN metastasis. The prediction
model for LN metastasis using these three factors revealed
good discrimination (area under the receiver operating
characteristics curve 0.874, P < 0.001). Negative for all
three factors (i.e. CA19-9 levels <37 IU/ml, peripheral
ICC and no LN swelling) identiﬁed 35 patients (27.6%)
as a low-risk group, with the false negative rate of 2.3%.
Conclusions We proposed a preoperative criterion for
predicting LN metastasis, giving rise to the identiﬁcation
of ICC patients who showed a low-risk of LN metastasis.
Keywords Intrahepatic cholangiocarcinoma
Lymph node metastasis
Intrahepatic cholangiocarcinoma (ICC) is the second most
common primary liver cancer after hepatocellular carci-
noma (HCC) [1, 2]. Surgery has been regarded as a poten-
tially curative treatment that provides ICC patients a
median overall survival (OS) of 14.4 to 38.8 months [3–8].
Several prognostic factors of ICC have been elucidated
after surgery. Of these, lymph node (LN) metastasis has
been accredited as a poor prognostic factor. According to
numerous studies [3–8], median OS for ICC patients with-
out LN metastasis is 19.0 to 37.6 months, whereas it is
only 9.0 to 22.9 months for patients with LN metastasis.
LN metastasis strongly impacts the prognosis of ICC after
surgery, highlighting the needs of adjuvant strategy [9, 10].
While, the reports of minimally invasive surgery (i.e.
laparoscopic liver resection without lymphadenectomy) for
ICC patients with clinically unsuspicious LN metastasis are
increasing [11, 12].
In the era of multiple strategic options, there has been
increased need for clinicians to provide accurate informa-
tion regarding the treatment options, such as its beneﬁts
and uncertainties. Therefore, data on the risk for LN
metastasis allows us to provide such information. How-
ever, current standard radiographic approach for LN
metastasis by computed tomography (CT) can provide
high speciﬁcity at 77–92%, but low sensitivity at 40.0–
50.0% . These data suggest that CT scan can
Department of Surgery, Graduate School of Medicine, Kyoto
University, Kyoto, Japan
E. Hatano (
Department of Surgery, Hyogo College of Medicine,
1-1 Mukogawa-cho, Nishinomiya, Hyogo 663-8501, Japan
Department of Gastroenterological Surgery and Oncology, Kitano
Hospital, Osaka, Japan
This study was presented at the joint congress of the 6th biennial
congress of the Asian-Paciﬁc Hepato-Pancreato-Biliary Association
(A-PHPBA) and the 29th meeting of the Japanese Society of
Hepato-Biliary-Pancreatic Surgery (JSHBPS).
J Hepatobiliary Pancreat Sci (2018) 25:299–307