Abstract：
BACKGROUND: Liver resection plus lymphadenectomy is essential to ensure precise staging in patients with intrahepatic cholangiocarcinoma (ICC). This study aimed to investigate the influence of the clinical status of lymph nodes on the survival outcomes in ICC patients.
METHODS: Between January 2015 and December 2020, consecutive patients diagnosed with ICC who underwent liver resection plus lymphadenectomy were enrolled. Clinical assessment of lymph node status included positron emission tomography/computed tomography examination by radiologists pre-operatively, alongside intraoperative abdominal examination by the surgical team. Retrospective collection and analysis of clinical information alongside survival data were performed to assess outcomes.
RESULTS: The study included a total of 359 patients, with 291 (81.0%) and 151 (42.1%) displaying clinically and pathologically positive lymph nodes, respectively. The clinical assessment method had a sensitivity of 81.2% and a specificity of 54.3%. Following a median follow-up period of 32 months, the overall survival (OS) rates at 1, 3, and 5 years were 69.1%, 50.6%, and 41.2%, respectively, while the disease-free survival (DFS) rates were 60.7%, 42.8%, and 40.1%, respectively, across the cohort. Patients who had clinically positive but pathologically negative lymph nodes recorded the highest median OS (52 months) and median DFS (32 months). Conversely, those who were clinically negative but pathologically positive experienced the lowest median OS (16 months) and median DFS (8 months).
CONCLUSIONS: The current approach to clinically assessing lymph node status in ICC has a significant rate of false positives. Patients with clinically positive but pathologically negative lymph nodes exhibit the most favourable survival outcomes.
METHODS: Between January 2015 and December 2020, consecutive patients diagnosed with ICC who underwent liver resection plus lymphadenectomy were enrolled. Clinical assessment of lymph node status included positron emission tomography/computed tomography examination by radiologists pre-operatively, alongside intraoperative abdominal examination by the surgical team. Retrospective collection and analysis of clinical information alongside survival data were performed to assess outcomes.
RESULTS: The study included a total of 359 patients, with 291 (81.0%) and 151 (42.1%) displaying clinically and pathologically positive lymph nodes, respectively. The clinical assessment method had a sensitivity of 81.2% and a specificity of 54.3%. Following a median follow-up period of 32 months, the overall survival (OS) rates at 1, 3, and 5 years were 69.1%, 50.6%, and 41.2%, respectively, while the disease-free survival (DFS) rates were 60.7%, 42.8%, and 40.1%, respectively, across the cohort. Patients who had clinically positive but pathologically negative lymph nodes recorded the highest median OS (52 months) and median DFS (32 months). Conversely, those who were clinically negative but pathologically positive experienced the lowest median OS (16 months) and median DFS (8 months).
CONCLUSIONS: The current approach to clinically assessing lymph node status in ICC has a significant rate of false positives. Patients with clinically positive but pathologically negative lymph nodes exhibit the most favourable survival outcomes.
摘要：
背景：肝切除加淋巴结清扫术对于确保肝内胆管癌（ICC）患者的精确分期至关重要。本研究旨在探讨淋巴结转移的临床状态对ICC患者生存结局的影响。
方法：在2015年1月至2020年12月之间，纳入了接受肝切除加淋巴结清扫术的连续ICC患者。淋巴结状态的临床评估包括术前放射科医师的正电子发射断层扫描/计算机断层扫描检查，手术团队进行的术中腹部检查。回顾性收集和分析临床信息以及生存数据以评估结果。
结果：本研究共纳入359名患者，291（81.0%）和151（42.1%）显示临床和病理阳性淋巴结，分别。临床评估方法的敏感性为81.2％，特异性为54.3％。在中位随访期32个月后，1年、3年和5年的总生存率（OS）为69.1%，50.6%,和41.2%，分别,无病生存率(DFS)为60.7%,42.8%,和40.1%，分别,整个队列。具有临床阳性但病理阴性淋巴结的患者记录最高的中位OS（52个月）和中位DFS（32个月）。相反，临床阴性但病理阳性的患者的中位OS(16个月)和中位DFS(8个月)最低.
结论：目前临床评估ICC淋巴结状态的方法具有显著的假阳性率。具有临床阳性但病理阴性淋巴结的患者表现出最有利的生存结果。
方法：在2015年1月至2020年12月之间，纳入了接受肝切除加淋巴结清扫术的连续ICC患者。淋巴结状态的临床评估包括术前放射科医师的正电子发射断层扫描/计算机断层扫描检查，手术团队进行的术中腹部检查。回顾性收集和分析临床信息以及生存数据以评估结果。
结果：本研究共纳入359名患者，291（81.0%）和151（42.1%）显示临床和病理阳性淋巴结，分别。临床评估方法的敏感性为81.2％，特异性为54.3％。在中位随访期32个月后，1年、3年和5年的总生存率（OS）为69.1%，50.6%,和41.2%，分别,无病生存率(DFS)为60.7%,42.8%,和40.1%，分别,整个队列。具有临床阳性但病理阴性淋巴结的患者记录最高的中位OS（52个月）和中位DFS（32个月）。相反，临床阴性但病理阳性的患者的中位OS(16个月)和中位DFS(8个月)最低.
结论：目前临床评估ICC淋巴结状态的方法具有显著的假阳性率。具有临床阳性但病理阴性淋巴结的患者表现出最有利的生存结果。
