Retrospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jan 21, 2015; 21(3): 935-943
Published online Jan 21, 2015. doi: 10.3748/wjg.v21.i3.935
Prognosis after resection for hepatitis B virus-associated intrahepatic cholangiocarcinoma
Zhen-Feng Wu, Xiao-Yu Wu, Nan Zhu, Zhe Xu, Wei-Su Li, Hai-Bin Zhang, Ning Yang, Xue-Quan Yao, Fu-Kun Liu, Guang-Shun Yang
Zhen-Feng Wu, Xiao-Yu Wu, Zhe Xu, Wei-Su Li, Xue-Quan Yao, Fu-Kun Liu, Department of Surgical Oncology, Jiangsu Province Hospital of Traditional Chinese Medicine, the Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing 210029, Jiangsu Province, China
Nan Zhu, Hai-Bin Zhang, Ning Yang, Guang-Shun Yang, Fifth Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai 200438, China
Author contributions: Yao XQ, Wu ZF, Wu XY and Zhu N conceived and designed the study; Wu ZF and Li WS acquired the data; Xu Z, Yang N and Liu FK controlled the quality of data and algorithms; Zhang HB, Wu ZF and Yang GS analysed and interpreted the data; Wu ZF and Liu FK performed statistical analysis; Wu ZF, Wu XY and Zhu N contributed equally to this work.
Supported by National Natural Science Foundation of China, No. 81402523.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Xue-Quan Yao, MD, Department of Surgical Oncology, Jiangsu Province Hospital of Traditional Chinese Medicine, the Affiliated Hospital of Nanjing University of Chinese Medicine, No. 155 Hanzhong Road, Nanjing 210029, Jiangsu Province, China. xuequan000@126.com
Telephone: +86-25-86617141 Fax: +86-25-86617141
Received: May 14, 2014
Peer-review started: May 14, 2014
First decision: June 18, 2014
Revised: July 12, 2014
Accepted: September 18, 2014
Article in press: September 19, 2014
Published online: January 21, 2015
Abstract

AIM: To investigate the prognostic factors after resection for hepatitis B virus (HBV)-associated intrahepatic cholangiocarcinoma (ICC) and to assess the impact of different extents of lymphadenectomy on patient survival.

METHODS: A total of 85 patients with HBV-associated ICC who underwent curative resection from January 2005 to December 2006 were analyzed. The patients were classified into groups according to the extent of lymphadenectomy (no lymph node dissection, sampling lymph node dissection and regional lymph node dissection). Clinicopathological characteristics and survival were reviewed retrospectively.

RESULTS: The cumulative 1-, 3-, and 5-year survival rates were found to be 60%, 18%, and 13%, respectively. Multivariate analysis revealed that liver cirrhosis (HR = 1.875, 95%CI: 1.197-3.278, P = 0.008) and multiple tumors (HR = 2.653, 95%CI: 1.562-4.508, P < 0.001) were independent prognostic factors for survival. Recurrence occurred in 70 patients. The 1-, 3-, and 5-year disease-free survival rates were 36%, 3% and 0%, respectively. Liver cirrhosis (HR = 1.919, P = 0.012), advanced TNM stage (stage III/IV) (HR = 2.027, P < 0.001), and vascular invasion (HR = 3.779, P = 0.02) were independent prognostic factors for disease-free survival. Patients with regional lymph node dissection demonstrated a similar survival rate to patients with sampling lymph node dissection. Lymphadenectomy did not significantly improve the survival rate of patients with negative lymph node status.

CONCLUSION: The extent of lymphadenectomy does not seem to have influence on the survival of patients with HBV-associated ICC, and routine lymph node dissection is not recommended, particularly for those without lymph node metastasis.

Keywords: Intrahepatic cholangiocarcinoma, Hepatitis B virus, Lymph node metastases, Postoperative survival, Lymph node dissection

Core tip: Some recently published studies show a relation between chronic hepatitis B infection and the development of intrahepatic cholangiocarcinoma. Hepatitis B-associated patients with cholangiocarcinoma appear to have different clinicopathological characteristics compared with seronegative patients. In this context, the authors analyzed the data of patients with hepatitis B virus-associated intrahepatic cholangiocarcinoma who underwent curative resection retrospectively. They found in multivariate analysis that liver cirrhosis and multiple tumors were independent prognostic factors for overall survival. Independent prognostic factors for disease-free survival were liver cirrhosis, vascular invasion and advanced TNM stage. The patients were divided into three groups depending on the extent of lymph node dissection (no lymph node dissection, sampling lymph node dissection and regional lymph node dissection). The outcomes were not statistically different between the three groups.