Prognostic value of lymphovascular invasion in Bismuth-Corlette type IV hilar cholangiocarcinoma.
AIM
To assess the prognostic value of lymphovascular invasion (LVI) in Bismuth-Corlette type IV hilar cholangiocarcinoma (HC) patients.


METHODS
A retrospective analysis was performed on 142 consecutively recruited type IV HC patients undergoing radical resection with at least 5 years of follow-up. Survival analysis was performed by the Kaplan-Meier method, and the association between the clinicopathologic variables and survival was evaluated by log-rank test. Multivariate analysis was adopted to identify the independent prognostic factors for overall survival (OS) and disease-free survival (DFS). Multiple logistic regression analysis was performed to determine the association between LVI and potential variables.


RESULTS
LVI was confirmed histopathologically in 29 (20.4%) patients. Multivariate analysis showed that positive resection margin (HR = 6.255, 95%CI: 3.485-11.229, P < 0.001), N1 stage (HR = 2.902, 95%CI: 1.132-7.439, P = 0.027), tumor size > 30 mm (HR = 1.942, 95%CI: 1.176-3.209, P = 0.010) and LVI positivity (HR = 2.799, 95%CI: 1.588-4.935, P < 0.001) were adverse prognostic factors for DFS. The independent risk factors for OS were positive resection margin (HR = 6.776, 95%CI: 3.988-11.479, P < 0.001), N1 stage (HR = 2.827, 95%CI: 1.243-6.429, P = 0.013), tumor size > 30 mm (HR = 1.739, 95%CI: 1.101-2.745, P = 0.018) and LVI positivity (HR = 2.908, 95%CI: 1.712-4.938, P < 0.001). LVI was associated with N1 stage and tumor size > 30 mm. Multiple logistic regression analysis indicated that N1 stage (HR = 3.312, 95%CI: 1.338-8.198, P = 0.026) and tumor size > 30 mm (HR = 3.258, 95%CI: 1.288-8.236, P = 0.013) were associated with LVI.


CONCLUSION
LVI is associated with N1 stage and tumor size > 30 mm and adversely influences DFS and OS in type IV HC patients.
['Li|Bei|B|', 'Xiong|Xian-Ze|XZ|', 'Zhou|Yong|Y|', 'Wu|Si-Jia|SJ|', 'You|Zhen|Z|', 'Lu|Jiong|J|', 'Cheng|Nan-Sheng|NS|']
D000328:Adult D000368:Aged D001650:Bile Duct Neoplasms D002758:Cholangiography D018572:Disease-Free Survival D005260:Female D005500:Follow-Up Studies D006500:Hepatic Duct, Common D006801:Humans D053208:Kaplan-Meier Estimate D018285:Klatskin Tumor D008207:Lymphatic Metastasis D008297:Male D008875:Middle Aged D009361:Neoplasm Invasiveness D009367:Neoplasm Staging D011379:Prognosis D012189:Retrospective Studies D012307:Risk Factors D055815:Young Adult
Lymphovascular invasion Hilar cholangiocarcinoma Overall survival Disease-free survival Bismuth-Corlette classification