Influence of lymph node-related parameters on postoperative long-term prognosis of patients with distal cholangiocarcinoma / 国际外科学杂志

ABSTRACT

Objective:To analyse the correlation between the lymph nodes, the number of positive lymph nodes, the positive rate of lymph nodes and the long-term prognosis of patients with distal cholangiocarcinoma.Methods:The clinical data and follow-up results of 104 patients with distal cholangiocarcinoma admitted to Beijing Chaoyang Hospital Affiliated to Capital Medical University from January 2015 to December 2021 were retrospectively analyzed using a retrospective cohort study. All patients underwent pancreaticoduodenectomy. According to the nature of the patients′ lymph nodes, the number of positive lymph nodes, and the positive rate of lymph nodes, the X-tile software was used to analyze data respectively, and the critical value of SUVmax were determined, and the patients were divided into low-risk group and high-risk group by critical values. Based on this critical value, the patients were divided into low-risk groups and high-risk groups. There were 37 patients in the lymph node positive group and 67 patients in the negative group. In the lymph node positive group, according to the number of positive lymph nodes (the cut-off value=2), they were divided into the low-risk group( n=14), the high-risk group( n=23); grouped according to the lymph node positive rate (the cut off=0.13), and divided into the low-risk group( n=15), and the high-risk group( n=22). After grouping according to different lymph node parameters, the preoperative general data such as age, gender, laboratory examination, etc., the correlation between perioperative complications and long-term prognosis were analyzed. The measurement data conforming to the normal distribution was expressed as mean ± standard deviation( ± s), and the t test was used for comparison between groups; the measurement data that was not normally distributed was expressed as M ( Q1, Q3), and the comparison between groups was performed by the rank sum test. The enumeration data were expressed by the number of cases, and the comparison between groups was performed using the chi-square test. If the total number of cases was less than 50, and Fisher′s exact test was used. The optimal cut-off values for different lymph node parameters were determined using the x-tile 3.6.1 software. Survival curves were calculated and drawn using the Kaplan-Meier method, and the survival rates were compared using the Log-rank test. Results:All patients successfully underwent the operation, 5 patients(4.8%) died during the perioperative period. The median postoperative survival time of lymph node-positive patients and lymph node-negative patients was 17 months and 36 months, respectively, and the overall survival rates at 1, 3, and 5 years were 64.9%, 23.9%, 23.9%, and 81.5%, 49.8%, 41.7%( P=0.003). Among the patients grouped according to the number of positive lymph nodes, the median postoperative survival time of patients in the low-risk group and the high-risk group was 21 months and 17 months, and the 1-, 3-, and 5-year overall survival rates of the two groups were were 77.1%, 42.9%, 42.9% and 58.2%, 13.8%, 13.8%( P=0.284), respectively. Among the patients grouped according to the positive rate of lymph nodes, the median postoperative survival time of the patients in the low-risk group and the high-risk group was 30 months and 15 months, and the 1-, 3-, and 5-year overall survival rates of the two groups were 85.6%, 42.7%, 42.7% and 51.3%, 10.3%, 0.3%( P=0.020), respectively. Conclusions:Radical pancreaticoduodenectomy is the standard procedure for patients with distal cholangiocarcinoma. The prognosis of patients with positive lymph nodes is worse. For patients with positive lymph nodes, the positive rate of lymph nodes is a better predictor of the long-term prognosis compared with the number of positive lymph nodes.