Prediction of regional lymph node metastasis in intrahepatic cholangiocarcinoma: it's not all about size.

Autor: Kolck J; Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany. johannes.kolck@charite.de., Auer TA; Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany.; BIH Biomedical Innovation Academy, Berlin Institute of Health at Charité -Universitätsmedizin Berlin, Berlin, Germany., Walter-Rittel T; Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany., Hosse C; Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany., Elkilany A; Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany., Marth AA; Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany., Pelzer U; Department of Hematology/Oncology, Charité - Universitätsmedizin Berlin, Berlin, Germany., Mohr R; Department of Hepatology and Gastroenterology, Charité - Universitätsmedizin Berlin, Berlin, Germany., Krenzien F; BIH Biomedical Innovation Academy, Berlin Institute of Health at Charité -Universitätsmedizin Berlin, Berlin, Germany.; Department of Surgery CCM/CVK, Charité - Universitätsmedizin Berlin, Berlin, Germany., Lurje G; Department of Surgery CCM/CVK, Charité - Universitätsmedizin Berlin, Berlin, Germany., Schöning W; Department of Surgery CCM/CVK, Charité - Universitätsmedizin Berlin, Berlin, Germany., Hamm B; Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany., Geisel D; Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany., Fehrenbach U; Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
Jazyk: angličtina
Zdroj: Abdominal radiology (New York) [Abdom Radiol (NY)] 2023 Oct; Vol. 48 (10), pp. 3063-3071. Date of Electronic Publication: 2023 Jun 24.
DOI: 10.1007/s00261-023-03991-1
Abstrakt: Objectives: Lymph node metastases (LNM) are frequent in patients with intrahepatic cholangiocarcinoma (iCC) and worsen their prognosis even after surgery. Our aim was to investigate the predictive value of lymph node (LN) short axis, the most common discriminator for identifying LNM in tumor-imaging and to develop a predictive model for regional LNM in iCC taking computed tomography (CT) features of extranodal disease into account.
Materials and Methods: We enrolled 102 patients with pathologically proven iCC who underwent CT prior to hepatic resection and hilar lymph node dissection (LND) from 2005 to 2021. Two blinded radiologists assessed various imaging characteristics and LN diameters, which were analyzed by bivariate and multivariate logistic regression to develop a prediction model for LNM.
Results: Prevalence of LNM was high (42.4 %) and estimated survival was shorter in LN-positive patients (p = 0.07). An LN short axis diameter of ≥ 9 mm demonstrated the highest predictive power for LNM. Three additional, statistically significant imaging features, presence of intrahepatic metastasis (p = 0.003), hilar tumor infiltration (p = 0.003), and tumor growth along the liver capsule (p = 0.004), were integrated into a prediction model, which substantially outperformed use of LN axis alone in ROC analysis (AUC 0.856 vs 0.701).
Conclusions: LN diameter alone proved to be a relevant but unreliable imaging-marker for LNM prediction in iCC. Our proposed prognostic model, which additionally considers intrahepatic metastases and hilar and capsular infiltration, significantly improves discriminatory power. Hilar and capsular involvement might indicate direct tumor extension to lymphatic liver structures.
(© 2023. The Author(s).)
Databáze: MEDLINE
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