The Prognosis and Survival Outcome of Intrahepatic Cholangiocarcinoma Following Surgical Resection: Association of Lymph Node Metastasis and Lymph Node Dissection with Survival
Department of Surgery, Korea University College of Medicine, Seoul, Korea. Annals of Surgical Oncology
(Impact Factor: 3.93).
08/2009; 16(11):3048-56. DOI: 10.1245/s10434-009-0631-1
Surgical resection has been shown to improve long-term survival for patients with intrahepatic cholangiocarcinoma (ICC). The benefit of lymph node dissection is still controversial. The aims of this study were to investigate the prognostic factors of ICC and to examine the impact of lymph node metastasis and extent of lymph node dissection on survival.
A total of 64 patients with ICC were operated on with curative intent and resultant macroscopic curative resection (R0 and R1). The patients were classified according to the extent of the lymph node dissection. Clinicopathological characteristics and survival were reviewed retrospectively.
All patients underwent anatomical resection. The 5-year survival rates were 39.5%. Multivariate analysis revealed that lymph node metastasis (hazard ratio: 3.317) was an independent prognostic factors on survival. Recurrence occurred in 41 patients. Median disease-free survival time was 12.3 months. Tumor differentiation was an independent prognostic factor for disease-free survival (hazard ratio: 3.158). The extent of lymph node dissection did not affect the occurrence of complication. Regional+alpha lymph node dissection group demonstrated similar survival to those of lymph node sampling group, although significant high incidence of lymph node metastases was observed in the regional+alpha lymph node dissection group. The extent of lymph node dissection did not affect the survival in the patients without lymph node involvement.
The regional+alpha lymph node dissection enhanced the survival in the ICC patients with lymph node metastasis, and the exact nodal status could be confirmed by lymph node dissection in the pericholedochal lymph nodes.
Available from: Timothy M Pawlik
- "While the liver is the most common site of recurrence (e.g., 50–60%), recurrence in regional lymph nodes or the peritoneum is not uncommon (e.g., 20–25%)  . A small subset of patients with liver only recurrence may be candidates for either ablation or re-resection   . Five-year survival and overall survival after surgical resection of iCCA ranges from 15% to 40% in most series [127,155,159–161]. "
Available from: plosone.org
- "Lymphatic vessel invasion and lymph node metastasis are major negative prognostic factors for CCA , . However, the mechanism by which tumor cells infiltrate the lymphatic system is still a subject of debate. "
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ABSTRACT: It has been shown that nerve growth factor-β (NGF-β) promoted the initiation and progression of many tumors, and we have previously demonstrated that the expression of NGF-β was associated with tumor stage, nerve infiltration and lymph node metastasis in human hilar cholangiocarcinoma. However, whether NGF-β promotes tumor progression in human cholangiocarcinoma requires further investigation. Therefore, we aimed to determine the effects of NGF-β on the progression of human cholangiocarcinoma.
Human cholangiocarcinoma QBC939 stable cell lines with over-expressed or silenced NGF-β genes were generated with pEGFP-N1-NGF-β and pGPU6/GFP/Neo-NGF-β-shRNA recombinant plasmids. Cell proliferation assay, colony formation assay, cell cycle analysis, apoptosis assay and tumorigenicity assay were performed to evaluate the role of NGF-β in the progression of human cholangiocarcinoma. In addition, human lymphatic endothelial cells were co-cultured with QBC939 culture supernatants, and the cell proliferation and migration abilities of the lymphatic endothelial cells were evaluated.
Forced expression of NGF-β in QBC939 cell lines promoted proliferation, colony formation and tumorigenicity in these cells and inhibited the apoptosis. However, down-regulation of NGF-β inhibited proliferation, colony formation and tumorigenicity, and increased the apoptotic rate of QBC939 cells. In addition, the NGF-β gain-of-function induced a high expression of vascular endothelial growth factor C and enhanced the proliferation and migration of lymphatic endothelial cells, while NGF-β loss-of-function showed opposite effects.
We concluded that NGF-β promoted tumor progression in human cholangiocarcinoma QBC939 cells. Our results provided a new concept to understand the role of NGF-β in cholangiocarcinoma progression, and might provide important information for the development of new targeted therapies in human cholangiocarcinoma.
Available from: ncbi.nlm.nih.gov
- "Discussion Combined hepatocellular-cholangiocarcinoma (CHC), a rare primary malignant tumor, accounts for1.2% to 14.2% in primary liver cancer    . Allen and Lisa  firstly reported 5 cases of the combined liver cell and bile duct carcinoma in 1949 and sorted them into three types. "
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ABSTRACT: Combined hepatocellular-cholangiocarcinoma which shows features of both hepatocellular and biliary epithelial differentiation is a rare form of primary liver cancer. The rarer is that the two types of cancer occur in the different lobe of the same liver concurrently.
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