A. Y. Son1, R. Shenoy1, C. G. Ethun2, G. Poultsides3, K. Idrees4, R. C. Fields5, S. M. Weber6, R. C. Martin7, P. Shen11, C. Schmidt9, S. K. Maithel2, T. M. Pawlik10, M. Melis1, E. Newman1, I. Hatzaras1 1New York University School Of Medicine,Surgery,New York, NY, USA 2Emory University School Of Medicine,Surgery,Atlanta, GA, USA 3Stanford University,Surgery,Palo Alto, CA, USA 4Vanderbilt University Medical Center,Surgery,Nashville, TN, USA 5Washington University,Surgery,St. Louis, MO, USA 6University Of Wisconsin,Surgery,Madison, WI, USA 7University Of Louisville,Surgery,Louisville, KY, USA 9Ohio State University,Surgery,Columbus, OH, USA 10Johns Hopkins University School Of Medicine,Surgery,Baltimore, MD, USA 11Wake Forest University School Of Medicine,Surgery,Winston-Salem, NC, USA
Introduction:
The ratio of metastatic to total harvested lymph nodes (LNR) is an important prognostic factor following resection of gastrointestinal malignancies. We assessed the prognostic value of LNR in patients undergoing resection for distal cholangiocarcinoma (DCC).
Methods:
Patients who underwent curative intent resection of DCC in 10 institutions of the US Extrahepatic Biliary Malignancy Collaborative were included. Descriptive statistics were used to evaluate characteristics of demographic data. Multivariate proportional hazards regression was used to identify factors associated with recurrence-free survival and overall survival.
Results:
A total of 265 were included (median age 67 years; 63.4% male): 199 with low-LNR (00.4). The high LNR group was less likely to have undergone a Whipple procedure (85.4% vs. 82.9% vs. 60.0%, p<0.01), had a higher proportion of margin-positive resection (19.6% vs. 19.5% vs. 45.8%, p<0.05), poor differentiation (26.2% vs. 36.6% vs. 52.2%, p<0.05), lymphovascular (44.3% vs. 74.3% vs. 88.2%, p<0.001) and perineural invasion (81.0% vs. 69.2% vs. 91.3%, p>0.05). Multivariate analysis showed high-LNR as an independent predictor of poor RFS (HR 4.6, 95%CI 1.8-11.8, p=0.001) and OS (HR 2.2, 95%CI 1.0-4.6, p<0.05) (Table 1). Rates of adjuvant chemoradiation in low-moderate LNR and high-LNR were 61.9% and 82.6%, respectively (p=0.07). Nevertheless, stratification by LNR showed no improvements in RFS or OS with either adjuvant chemoradiation.
Conclusion:
LNR can be used as a prognostic factor for recurrence and survival in patients undergoing curative-intent resection for DCC. Every effort should be made to perform an oncologic resection, with negative margins and adequate lymph node harvest, as adjuvant chemoradiation does not appear to provide LNR-specific improvements in long-term prognosis.