Background: The objective of the current study was to develop a model to predict the likelihood of occult lymph node metastasis (LNM) prior to resection of intrahepatic cholangiocarcinoma (ICC). Methods: Patients who underwent hepatectomy for ICC between 2000 and 2017 were identified using a multi-institutional database. A novel model incorporating clinical and preoperative imaging data was developed to predict LNM. Results: Among 980 patients who underwent resection of ICC, 190 (19.4%) individuals had at least one LNM identified on final pathology. An enhanced imaging model incorporating clinical and imaging data was developed to predict LNM (https://k-sahara.shinyapps.io/ICC_imaging/). The performance of the enhanced imaging model was very good in the training data set (c-index 0.702), as well as the validation data set with bootstrapping resamples (c-index 0.701) and outperformed the preoperative imaging alone (c-index 0.660). The novel model predicted both 5-year overall survival (OS) (low risk 48.4% vs. high risk 18.4%) and 5-year disease-specific survival (DSS) (low risk 51.9% vs. high risk 25.2%, both p < 0.001). When applied among Nx patients, 5-year OS and DSS of low-risk Nx patients was comparable with that of N0 patients, while high-risk Nx patients had similar outcomes to N1 patients (p > 0.05). Conclusion: This tool may represent an opportunity to stratify prognosis of Nx patients and can help inform clinical decision-making prior to resection of ICC.

Additional Metadata
Keywords ICC, lymph node, metastasis, survival
Persistent URL dx.doi.org/10.1007/s11605-020-04720-5, hdl.handle.net/1765/129395
Journal Journal of Gastrointestinal Surgery
Citation
Tsilimigras, D.I. (Diamantis I.), Sahara, K. (Kota), Paredes, A.Z. (Anghela Z.), Moro, A. (Amika), Mehta, R. (Rittal), Moris, D. (Dimitrios), … Pawlik, T.M. (2020). Predicting Lymph Node Metastasis in Intrahepatic Cholangiocarcinoma. Journal of Gastrointestinal Surgery. doi:10.1007/s11605-020-04720-5