A preoperative scoring system to predict lymph node metastasis in intrahepatic cholangiocarcinoma

Hyungjin Rhee, Hyun Ji Lim, Kyunghwa Han, Suk Keu Yeom, Sang Hyun Choi, Ji Hoon Park, Eun Suk Cho, Sumi Park, Mi Jung Lee, Gi Hong Choi, Dai Hoon Han, Seung Soo Lee, Mi Suk Park

Research output: Contribution to journalArticlepeer-review


Background: The abnormality of imaging finding of lymph node (LN) has demonstrated unsatisfactory diagnostic accuracy for pathologic lymph node metastasis (LNM). We aimed to develop and validate a simple scoring system predicting LNM in patients with intrahepatic cholangiocarcinoma (iCCA) prior to surgery based on MRI and clinical findings. Methods: We retrospectively enrolled consecutive patients who underwent surgical resection for treatment-naïve iCCA from six institutions between January 2009 and December 2015. Patients who underwent lymph node dissection (LND) were randomly assigned to the training and validation cohorts at a 2:1 ratio, an¹ìd pathologic LN status was evaluated. Patients who did not undergo LND were assigned to the test cohort, and clinical LN status was evaluated. Using MRI and clinical findings, a preoperative LNM score was developed in the training cohort and validated in the validation and test cohorts. Results: The training, validation, and test cohorts included 102, 53, and 118 patients, respectively. The preoperative LNM score consisted of serum carcinoembryonic antigen and two MRI findings (suspicious LN and bile duct invasion). The preoperative LNM score was associated with pathologic LNM in training (p < 0.001) and validation (p = 0.010) cohorts and clinical LNM in test cohort (p < 0.001). The preoperative LNM score outperformed MRI-suspicious LN alone in predicting pathologic LNM (area under the curve, 0.703 vs. 0.604, p = 0.004). The preoperative LNM score was also associated with overall survival in all cohorts (p < 0.001). Conclusions: Our preoperative LNM score was significantly associated with pathologic or clinical LNM and outperformed MRI-suspicious LN alone.

Original languageEnglish
JournalHepatology International
Publication statusAccepted/In press - 2023

Bibliographical note

Funding Information:
This study was supported by the Research Supporting Program of the Korean Association for the Study of the Liver and the Korean Liver Foundation.

Publisher Copyright:
© 2023, Asian Pacific Association for the Study of the Liver.

All Science Journal Classification (ASJC) codes

  • Hepatology


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