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Prognostic value of lymphadenectomy in intra-hepatic cholangiocarcinoma : a systematic review and meta-analysis
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Introdução: O colangiocarcinoma intra-hepático (iCCA) é um cancro primário do fígado com mau prognóstico, e o papel da linfadenectomia (LND) no seu tratamento cirúrgico permanece controverso. Este estudo tem como objetivo avaliar o impacto da LND na sobrevida global (SG) em pacientes submetidos à ressecção hepática para CCA intra-hepático (iCCA).
Metodologia: Foi realizada uma revisão sistemática e meta-análise seguindo as diretrizes PRISMA. Realizou-se uma pesquisa abrangente no Medline e Web of Science até outubro de 2023. Foram incluídos estudos comparando OS entre pacientes com e sem LND durante a ressecção de iCCA. A extração de dados e a avaliação da qualidade foram realizadas de forma independente por vários revisores. Razões de risco (HR) com intervalos de confiança (IC) de 95% foram calculadas usando um modelo de efeitos aleatórios.
Resultados: Foram incluídos 23 estudos com um total de 12309 pacientes. A meta-análise não mostrou diferença significativa na OS entre os grupos LND e não-LND (HR: 0,86; IC 95%: 0,66; 1,13; p = 0,290). No entanto, a análise de subgrupo revelou maior OS em pacientes com gânglios clinicamente negativos (cN0) submetidos a LND (HR: 0,68; IC 95%: 0,56, 0,86; p = 0,020). LND adequada, definida como ≥6 gânglios, foi associado a uma SG significativamente maior (HR: 0,79; IC 95%: 0,66; 0,96; p < 0,01). Os pacientes LNM-negativos apresentaram maior SG em comparação aos pacientes LNM-positivos (HR: 3,11; IC 95%: 2,21; 4,37; p < 0,01).
Conclusão: A LND está associada à melhoria da sobrevida em pacientes com cN0 e quando um número adequado de gânglios é examinado. Estas descobertas apoiam a implementação standard de LND em todos os pacientes para aumentar a precisão do prognóstico e melhorar os resultados. Mais pesquisas, incluindo ensaios clínicos randomizados, são necessárias para confirmar esses achados e melhorar estratégias cirúrgicas para iCCA.
Introduction: Intra-hepatic cholangiocarcinoma (iCCA) is a primary liver cancer with poor prognosis, and the role of lymphadenectomy (LND) in its surgical management remains controversial. This study aims to evaluate the impact of LND on overall survival (OS) in patients undergoing hepatic resection for intrahepatic CCA (iCCA). Methods: A systematic review and meta-analysis were conducted following PRISMA guidelines. A comprehensive search was performed in Medline and Web of Science up to October 2023. Studies comparing OS between patients with and without LND during iCCA resection were included. Data extraction and quality assessment were performed independently by multiple reviewers. Hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated using a random-effects model. Results: 23 studies with a total of 12309 patients were included. Meta-analysis showed no significant difference in OS between LND and non-LND groups (HR: 0.86; 95% CI: 0.66, 1.13; p = 0.290). However, subgroup analysis revealed higher OS in clinically node-negative (cN0) patients undergoing LND (HR: 0.68; 95% CI: 0.56, 0.86; p = 0.020). Adequate LND, defined as ≥6 lymph nodes, was associated with significantly improved OS (HR: 0.79; 95% CI: 0.66, 0.96; p < 0.01). LNM-negative patients had higher OS compared to LNM-positive patients (HR: 3.11; 95% CI: 2.21, 4.37; p < 0.01). Conclusion: LND is associated with improved survival in cN0 patients and when an adequate number of lymph nodes are examined. These findings support the routine implementation of LND in all patient subgroups to enhance prognostic accuracy and improve outcomes. Further research, including randomized controlled trials, is needed to confirm these findings and refine surgical strategies for iCCA.
Introduction: Intra-hepatic cholangiocarcinoma (iCCA) is a primary liver cancer with poor prognosis, and the role of lymphadenectomy (LND) in its surgical management remains controversial. This study aims to evaluate the impact of LND on overall survival (OS) in patients undergoing hepatic resection for intrahepatic CCA (iCCA). Methods: A systematic review and meta-analysis were conducted following PRISMA guidelines. A comprehensive search was performed in Medline and Web of Science up to October 2023. Studies comparing OS between patients with and without LND during iCCA resection were included. Data extraction and quality assessment were performed independently by multiple reviewers. Hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated using a random-effects model. Results: 23 studies with a total of 12309 patients were included. Meta-analysis showed no significant difference in OS between LND and non-LND groups (HR: 0.86; 95% CI: 0.66, 1.13; p = 0.290). However, subgroup analysis revealed higher OS in clinically node-negative (cN0) patients undergoing LND (HR: 0.68; 95% CI: 0.56, 0.86; p = 0.020). Adequate LND, defined as ≥6 lymph nodes, was associated with significantly improved OS (HR: 0.79; 95% CI: 0.66, 0.96; p < 0.01). LNM-negative patients had higher OS compared to LNM-positive patients (HR: 3.11; 95% CI: 2.21, 4.37; p < 0.01). Conclusion: LND is associated with improved survival in cN0 patients and when an adequate number of lymph nodes are examined. These findings support the routine implementation of LND in all patient subgroups to enhance prognostic accuracy and improve outcomes. Further research, including randomized controlled trials, is needed to confirm these findings and refine surgical strategies for iCCA.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2024
Palavras-chave
Colangiocarcinoma intra-hepático Linfadenectomia Sobrevivência global