Prognostic Value of Lymph Node Dissection for Intrahepatic Cholangiocarcinoma Patients With Clinically Negative Lymph Node Metastasis: A Multi-Center Study From China

Background Clinical value of lymph-node dissection (LND) for intrahepatic carcinoma (ICC) patients with clinically negative lymph node metastasis (LNM) remains unclear, hence we conducted a multi-center study to explore it. Methods Patients who were diagnosed ICC with clinically negative LNM and underwent hepatectomy with or without LND from December 2012 to December 2015 were retrospectively collected from 12 hepatobiliary centers in China. Overall survival (OS) was analyzed using the Kaplan-Meier method, and then subgroup analysis was conducted stratified by variables related to the prognosis. Results A total of 380 patients were eligible including 106 (27.9%) in the LND group and 274 (72.1%) in the non-LND group. Median OS in the LND group was slightly longer than that in the non-LND group (24.0 vs. 18.0 months, P=0.30), but significant difference was observed between the two groups (24.0 vs. 14.0 months, P=0.02) after a well-designed 1:1 propensity score matching without increased severe complications. And, LND was identified to be one of the independent risk factors of OS (HR=0.66, 95%CI=0.46-0.95, P=0.025). Subgroup analysis in the matched cohort showed that patients could be benefited more from LND, if they were being male, age 5 cm, single tumor, mass-forming, no satellite, no MVI, and no perineural invasion (all P<0.05). Furthermore, only patients with pathologically-confirmed positive LNM were found to be benefited from postoperative adjuvant therapy (P<0.001). Conclusion With the current data, we concluded that LND would benefit the selected ICC patients with clinically negative LNM, and might guide the postoperative management.