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Background <p>Lymph node metastasis (LNM) is a poor prognostic factor in intrahepatic cholangiocarcinoma (iCCA). However, the clinical benefit of R0 resection in patients with LNM is uncertain. This study evaluates the influence of LNM on the prognostic significance of resection margin (RM) status in iCCA.</p> Methods <p>A retrospective analysis was conducted on 170 patients who underwent curative-intent liver resection for iCCA. Patients were categorized into LNM-negative (<i>n</i> = 87) and LNM-positive (<i>n</i> = 83) groups. Survival outcomes were compared based on RM status (R0 vs. R1 resection) in each group. Prognostic factors were analyzed using multivariable Cox proportional hazards regression.</p> Results <p>LNM-positive patients had significantly worse survival than LNM-negative patients (median survival time (MST): 9.8 vs. 19.9 months, <i>p</i> &lt; 0.001). In LNM-negative patients, R0 resection showed a clinically meaningful, albeit not statistically significant, survival benefit (MST: 21.0 vs. 16.9 months, <i>p</i> = 0.145). However, in LNM-positive patients, R0 and R1 resections had comparable survival outcomes (MST: 11.1 vs. 9.0 months, <i>p</i> = 0.329). Multiple tumors were an independent poor prognostic factor in LNM-negative patients (HR 4.155, <i>p</i> = 0.004), while adjuvant therapy significantly improved survival in LNM-positive patients (HR 0.529, <i>p</i> = 0.009).</p> Conclusion <p>Our findings support a tailored surgical strategy. For LNM-negative patients, achieving an R0 resection remains critical. Conversely, for LNM-positive patients, resection margin status did not influence survival, and the surgical focus should shift towards a safe resection that preserves the patient’s fitness for essential multimodal therapy, which was independently associated with improved survival.</p>

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Resection Margin and Lymph Node Metastasis in Intrahepatic Cholangiocarcinoma: Does Margin Status Matter in Nodal Disease?

  • 期刊论文

  • 发表日期：

    2025年11月7日

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  • Poowanai Sarkhampee,
  • Weeris Ouransatien,
  • Satsawat Chansitthichok,
  • Nithi Lertsawatvicha,
  • Paiwan Wattanarath

摘要

Background

Lymph node metastasis (LNM) is a poor prognostic factor in intrahepatic cholangiocarcinoma (iCCA). However, the clinical benefit of R0 resection in patients with LNM is uncertain. This study evaluates the influence of LNM on the prognostic significance of resection margin (RM) status in iCCA.

Methods

A retrospective analysis was conducted on 170 patients who underwent curative-intent liver resection for iCCA. Patients were categorized into LNM-negative (n = 87) and LNM-positive (n = 83) groups. Survival outcomes were compared based on RM status (R0 vs. R1 resection) in each group. Prognostic factors were analyzed using multivariable Cox proportional hazards regression.

Results

LNM-positive patients had significantly worse survival than LNM-negative patients (median survival time (MST): 9.8 vs. 19.9 months, p < 0.001). In LNM-negative patients, R0 resection showed a clinically meaningful, albeit not statistically significant, survival benefit (MST: 21.0 vs. 16.9 months, p = 0.145). However, in LNM-positive patients, R0 and R1 resections had comparable survival outcomes (MST: 11.1 vs. 9.0 months, p = 0.329). Multiple tumors were an independent poor prognostic factor in LNM-negative patients (HR 4.155, p = 0.004), while adjuvant therapy significantly improved survival in LNM-positive patients (HR 0.529, p = 0.009).

Conclusion

Our findings support a tailored surgical strategy. For LNM-negative patients, achieving an R0 resection remains critical. Conversely, for LNM-positive patients, resection margin status did not influence survival, and the surgical focus should shift towards a safe resection that preserves the patient’s fitness for essential multimodal therapy, which was independently associated with improved survival.