Prognostic value of lymph node dissection for intrahepatic cholangiocarcinoma: A meta-analysis

doi:10.3877/cma.j.issn.1674-0793.2023.02.017

Abstract

Abstract:

Objective

To investigate the prognostic value of lymph node dissection (LND) for intrahepatic cholangiocarcinoma (ICC) patients.

Methods

From January 2012 to October 2022, the literature included in PubMed, EmBase, Web of Science, Cochrane, Wanfang Data, and CNKI database was retrieved. The literature required that the surgical intervention of ICC was divided into two groups: lymph node dissection (LND+ group) and non-lymph node dissection (LND-group) to analyze the effect of lymph node dissection on patient outcomes.

Results

A total of 5 449 patients from 21 studies were included, and the results of meta-analysis showed that LND did not improve the overall survival (OS). OS of patients in the N1 group was lower than that in the LND-group (HR=2.75, 95% CI: 1.73-4.36, P<0.05), and the OS of N0 group was higher than that of N1 group (HR=0.35, 95% CI: 0.31-0.40, P<0.001), which was not significantly different from the LND-group. Subgroup analysis showed that LND significantly increased OS of the R0 resection subgroup (HR=0.60, 95% CI: 0.44-0.81, P<0.01), but did not improve OS of the clinically lymph node metastasis subgroup and non-R0 resection subgroup, and the OS of patients in the N0 group was higher than that in the LND-group (HR=0.75, 95% CI: 0.58-0.97, P<0.05). The complication rate in the LND+ group was significantly higher than that in the LND-group (OR=1.88, 95% CI: 1.35-2.62, P<0.001). There was no statistically significant difference in postoperative recurrence rates between two groups.

Conclusion

The survival benefit of LND in patients with clinically node-negative ICC is not obvious, but routine LND may be a more conservative way when it is not clear whether systemic metastasis exists.

Key words: Intrahepatic cholangiocarcinoma, Lymph node dissection, Prognosis, Meta-analysis

Jinlong Zhou, Junjie Liu, Hao Gu. Prognostic value of lymph node dissection for intrahepatic cholangiocarcinoma: A meta-analysis[J]. Chinese Archives of General Surgery(Electronic Edition), 2023, 17(02): 155-160.

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URL: https://zhptwkxwx.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-0793.2023.02.017

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Figures/Tables 10

References 31

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第一作者	发表年	国家	样本量(例)	性别(例)		淋巴结清扫(例)		多中心	匹配方式	中位随访时间(月)	R0切除	质量评分
第一作者	发表年	国家	样本量(例)	男	女	LND+	LND-	多中心	匹配方式	中位随访时间(月)	R0切除	质量评分
Chang^[7]	2017	中国	103	54	49	36	67	否	无	-	非	6
Hu^[8]	2017	中国	422	177	245	73	349	否	无	-	非	5
Miyata^[9]	2017	日本	64	16	48	23	41	否	无	37	是	6
Xiao^[10]	2017	中国	49	-	-	35	14	否	无	-	非	5
Ke^[12]	2021	中国	212	110	102	106	106	是	PSM	-	是	8
Kim^[13]	2015	韩国	215	138	77	113	102	否	无	-	非	6
Wu^[14]	2015	中国	85	66	19	50	35	否	无	-	是	4
Li^[15]	2013	中国	114	-	-	53	61	否	无	-	是	6
Kim^[16]	2019	韩国	68	38	30	34	34	否	PSM	65	是	7
Hu^[17]	2021	美国	2 037	976	1 061	859	859	是	PSM	23	非	8
Yoh^[18]	2019	法国、日本	112	63	49	56	56	是	PSM	28	非	8
Umeda^[19]	2022	日本	310	181	129	224	86	是	IPTW	26	是	8
Vitale^[20]	2016	美国	402	200	202	201	201	是	PSM	-	非	8
高彪^[21]	2021	中国	162	87	75	94	68	否	无	36	是	6
戴高凡^[22]	2021	中国	81	35	46	39	42	否	无	35	是	6
季鸿翔^[23]	2017	中国	154	100	54	77	77	否	PSM	34	是	7
王垒^[24]	2020	中国	286	156	130	143	143	是	PSM	-	是	8
谭志国^[25]	2021	中国	135	64	71	72	63	否	无	32	是	5
黄徐建^[26]	2020	中国	142	77	65	86	56	否	无	41	是	5
Choi^[27]	2009	韩国	64	43	21	51	13	否	无	-	非	5
Hu^[28]	2021	中国	232	127	105	177	55	是	IPTW	19	非	8

第一作者	发表年	国家	样本量(例)	性别(例)		淋巴结清扫(例)		多中心	匹配方式	中位随访时间(月)	R0切除	质量评分
第一作者	发表年	国家	样本量(例)	男	女	LND+	LND-	多中心	匹配方式	中位随访时间(月)	R0切除	质量评分
Chang^[7]	2017	中国	103	54	49	36	67	否	无	-	非	6
Hu^[8]	2017	中国	422	177	245	73	349	否	无	-	非	5
Miyata^[9]	2017	日本	64	16	48	23	41	否	无	37	是	6
Xiao^[10]	2017	中国	49	-	-	35	14	否	无	-	非	5
Ke^[12]	2021	中国	212	110	102	106	106	是	PSM	-	是	8
Kim^[13]	2015	韩国	215	138	77	113	102	否	无	-	非	6
Wu^[14]	2015	中国	85	66	19	50	35	否	无	-	是	4
Li^[15]	2013	中国	114	-	-	53	61	否	无	-	是	6
Kim^[16]	2019	韩国	68	38	30	34	34	否	PSM	65	是	7
Hu^[17]	2021	美国	2 037	976	1 061	859	859	是	PSM	23	非	8
Yoh^[18]	2019	法国、日本	112	63	49	56	56	是	PSM	28	非	8
Umeda^[19]	2022	日本	310	181	129	224	86	是	IPTW	26	是	8
Vitale^[20]	2016	美国	402	200	202	201	201	是	PSM	-	非	8
高彪^[21]	2021	中国	162	87	75	94	68	否	无	36	是	6
戴高凡^[22]	2021	中国	81	35	46	39	42	否	无	35	是	6
季鸿翔^[23]	2017	中国	154	100	54	77	77	否	PSM	34	是	7
王垒^[24]	2020	中国	286	156	130	143	143	是	PSM	-	是	8
谭志国^[25]	2021	中国	135	64	71	72	63	否	无	32	是	5
黄徐建^[26]	2020	中国	142	77	65	86	56	否	无	41	是	5
Choi^[27]	2009	韩国	64	43	21	51	13	否	无	-	非	5
Hu^[28]	2021	中国	232	127	105	177	55	是	IPTW	19	非	8

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