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Introduction <p>The oncologic impact of lymph node dissection (LND) for intrahepatic cholangiocarcinoma (iCCA) remains unclear. We hypothesized that the prognostic relevance of LND may vary according to tumor burden. Therefore, this study sought to evaluate the interaction between tumor burden and adequate LND among patients who underwent curative-intent resection for iCCA.</p> Methods <p>Patients who underwent curative-intent liver resection for iCCA were identified from a large international multi-institutional database. Overall survival (OS) was evaluated using multivariable Cox regression models that included an interaction term between tumor burden score (TBS) and adequate LND.</p> Results <p>Among 1,558 patients, 872 (56.0%) underwent LND and 322 (20.7%) underwent adequate LND, defined as retrieval of at least six lymph nodes. The median TBS was 6.1 (interquartile range [IQR] 4.1–8.6). On multivariable Cox regression analysis, a significant interaction was observed between TBS and adequate LND (hazard ratio [HR] 0.91, 95% confidence interval [CI] 0.87–0.95, <i>p</i> &lt; 0.001). Among 542 (34.8%) patients with TBS &lt;&#xa0;5.0, adjusted OS did not differ according to adequate LND status (HR 1.23, 95% CI 0.86–1.76, <i>p</i> = 0.265). In contrast, among 1,016 (65.2%) patients with TBS ≥&#xa0;5.0, adequate LND was associated with improved adjusted OS (HR 0.65, 95% CI 0.51–0.82, <i>p</i>&#xa0;&lt;&#xa0;0.001). Similar findings were observed for recurrence-free survival (RFS).</p> Conclusions <p>The prognostic relevance of adequate LND in patients undergoing curative-intent resection for iCCA appears to vary according to tumor burden. Adequate LND was associated with improved OS and RFS among patients with high TBS, but not among those with low TBS.</p>

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Tumor Burden Modifies the Prognostic Impact of Adequate Lymph Node Dissection in Patients Undergoing Curative-Intent Resection for Intrahepatic Cholangiocarcinoma

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年6月14日

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  • Jun Kawashima,
  • Kota Sahara,
  • Kizuki Yuza,
  • Yutaka Endo,
  • François Cauchy,
  • Federico Aucejo,
  • Hugo P. Marques,
  • Rita Lopes,
  • Andreia Rodriguea,
  • Tom Hugh,
  • Feng Shen,
  • Shishir K. Maithel,
  • Bas Groot Koerkamp,
  • Irinel Popescu,
  • Minoru Kitago,
  • Matthew J. Weiss,
  • Guillaume Martel,
  • Carlo Pulitano,
  • Luca Aldrighetti,
  • George Poultsides,
  • Andrea Ruzzente,
  • Todd W. Bauer,
  • Ana Gleisner,
  • Yuki Homma,
  • Itaru Endo,
  • Timothy M. Pawlik

摘要

Introduction

The oncologic impact of lymph node dissection (LND) for intrahepatic cholangiocarcinoma (iCCA) remains unclear. We hypothesized that the prognostic relevance of LND may vary according to tumor burden. Therefore, this study sought to evaluate the interaction between tumor burden and adequate LND among patients who underwent curative-intent resection for iCCA.

Methods

Patients who underwent curative-intent liver resection for iCCA were identified from a large international multi-institutional database. Overall survival (OS) was evaluated using multivariable Cox regression models that included an interaction term between tumor burden score (TBS) and adequate LND.

Results

Among 1,558 patients, 872 (56.0%) underwent LND and 322 (20.7%) underwent adequate LND, defined as retrieval of at least six lymph nodes. The median TBS was 6.1 (interquartile range [IQR] 4.1–8.6). On multivariable Cox regression analysis, a significant interaction was observed between TBS and adequate LND (hazard ratio [HR] 0.91, 95% confidence interval [CI] 0.87–0.95, p < 0.001). Among 542 (34.8%) patients with TBS < 5.0, adjusted OS did not differ according to adequate LND status (HR 1.23, 95% CI 0.86–1.76, p = 0.265). In contrast, among 1,016 (65.2%) patients with TBS ≥ 5.0, adequate LND was associated with improved adjusted OS (HR 0.65, 95% CI 0.51–0.82, p < 0.001). Similar findings were observed for recurrence-free survival (RFS).

Conclusions

The prognostic relevance of adequate LND in patients undergoing curative-intent resection for iCCA appears to vary according to tumor burden. Adequate LND was associated with improved OS and RFS among patients with high TBS, but not among those with low TBS.