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Purpose <p>&#xa0;Lymph node metastasis (LNM) is a crucial prognostic indicator in perihilar cholangiocarcinoma (pCCA); however, preoperative tools for assessing LNM risk and determining the optimal extent of lymph node (LN) dissection remain limited. This study aimed to identify preoperative LNM predictors to guide regional LN dissections.</p> Methods <p>This multi-institutional retrospective study included 364 patients who underwent curative-intent pCCA resection (2020–2024). Multivariate logistic regression was used to identify independent predictors of preoperative LNM.</p> Results <p>Eventually, 148 (40.7%) patients were pathologically LNM-positive. The independent preoperative predictors were age &lt; 65&#xa0;years (odds ratio [OR]: 1.634, P = 0.041), carbohydrate antigen 19–9 (CA19-9) ≥ 200 U/mL (OR: 1.868, P = 0.006), and imaging suspicion of LNM (OR: 2.863, P = 0.001). The high-risk group (imaging suspicion of LNM + CA19-9 ≥ 200 U/mL or age &lt; 65&#xa0;years) had a 66.0% pathological LNM rate, and ≥ 6 LN dissections significantly improved recurrence-free survival (RFS) compared to &lt; 6 LN dissections (P = 0.002). The low-risk group (no risk factors) had a 23.5% pathological LNM rate, and no RFS difference was observed between the groups (P = 0.360).</p> Conclusions <p>Preoperative imaging suspicion of LNM, elevated CA19-9 levels, and younger age can effectively identify the high-risk group with LNM in pCCA. Adequate LN dissection may be associated with improved recurrence-free survival in the high-risk group, suggesting a risk-stratified approach to the extent of LN dissection.</p>

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Preoperative identification of high-risk patients for lymph node metastasis and the surgical dissection strategy in perihilar cholangiocarcinoma treated with curative-intent resection: a multicenter retrospective study

  • 期刊论文

  • 发表日期：

    2026年7月24日

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  • Rui Jian,
  • Hao-Yu Yang,
  • Long-Fei Ren,
  • Hong-Mei Jian,
  • Peng Zhao,
  • Jie Bai,
  • Yan Jiang,
  • Zhi-Xin Wang,
  • Shu-Jie Pang,
  • Xing-Chao Liu,
  • Yu-Le Luo,
  • Rui Guo,
  • Hai-Su Dai,
  • Zhi-Yu Chen,
  • Zhi-Peng Liu,
  • Yi Gong

摘要

Purpose

 Lymph node metastasis (LNM) is a crucial prognostic indicator in perihilar cholangiocarcinoma (pCCA); however, preoperative tools for assessing LNM risk and determining the optimal extent of lymph node (LN) dissection remain limited. This study aimed to identify preoperative LNM predictors to guide regional LN dissections.

Methods

This multi-institutional retrospective study included 364 patients who underwent curative-intent pCCA resection (2020–2024). Multivariate logistic regression was used to identify independent predictors of preoperative LNM.

Results

Eventually, 148 (40.7%) patients were pathologically LNM-positive. The independent preoperative predictors were age < 65 years (odds ratio [OR]: 1.634, P = 0.041), carbohydrate antigen 19–9 (CA19-9) ≥ 200 U/mL (OR: 1.868, P = 0.006), and imaging suspicion of LNM (OR: 2.863, P = 0.001). The high-risk group (imaging suspicion of LNM + CA19-9 ≥ 200 U/mL or age < 65 years) had a 66.0% pathological LNM rate, and ≥ 6 LN dissections significantly improved recurrence-free survival (RFS) compared to < 6 LN dissections (P = 0.002). The low-risk group (no risk factors) had a 23.5% pathological LNM rate, and no RFS difference was observed between the groups (P = 0.360).

Conclusions

Preoperative imaging suspicion of LNM, elevated CA19-9 levels, and younger age can effectively identify the high-risk group with LNM in pCCA. Adequate LN dissection may be associated with improved recurrence-free survival in the high-risk group, suggesting a risk-stratified approach to the extent of LN dissection.