Prognostic value of lymphovascular invasion in Bismuth-Corlette type IV hilar cholangiocarcinoma

Table 1 Demographics and operative outcomes

Characteristic	n (%)
Age (yr)1	59 (23-78)
Gender
Male	75 (52.8)
Female	67 (47.2)
Albumin level (g/L)2	36.74 ± 4.93
CA19-9
> 200	82 (57.7)
< 200	60 (42.3)
Radiological examination
Contrast-enhanced US	8 (5.6)
Contrast-enhanced CT	43 (30.3)
MRI + MRCP	91 (64.1)
Operative time (min)2	429.47 ± 134.19
Blood loss (ml)1	600 (180-4000)
Transfusion	76 (53.5)
R0 resection	107 (75.4)
Differentiation degree
Well differentiated	14 (9.9)
Moderately differentiated	90 (63.4)
Poorly differentiated	38 (26.8)
Perineutral invasion positive	69 (48.6)
N stage
N0	89 (62.7)
N1	53 (37.3)
Tumor diameter (mm)1	30 (12-55
Hospital stay1	19 (5-115)

¹Parameters are presented as median and range;

²Parameters are presented as mean ± SD.

Table 2 Potential prognostic factors for disease-free survival and overall survival after radical resection for type IV hilar cholangiocarcinoma patients excluding operative mortality n (%)

Variable	Disease-free survival				Overall survival
	5-yr survival	Univariate analysis	Multivariate analysis		5-yr survival	Univariate analysis	Multivariate analysis
		P value	HR (95%CI)	P value		P value	HR (95%CI)	P value
Gender		0.682				0.965
Male	13 (18.8)				14 (20.3)
Female	10 (16.4)				10 (16.4)
Age (yr)		0.039	1.291 (0.680-2.453)	0.435		0.230
< 65	19 (19.2)				20 (20.2)
> 65	4 (12.9)				4 (12.9)
CA19-9		0.287				0.301
< 200	13 (23.2)				14 (25)
> 200	10 (13.5)				10 (13.5)
ALB (g/L)		0.005	0.669 (0.413-1.085)	0.103		0.009	0.760 (0.492-1.173)	0.215
< 35	3 (7.1)				3 (7.1)
> 35	21 (23.9)				20 (22.7)
Surgical method		0.847				0.684
Left-sided hepatectomy	13 (15.1)				13 (15.1)
Right-sided hepatectomy	10 (17.2)				11 (19.0)
Resection margin		< 0.001	6.255 (3.485-11.229)	< 0.001		< 0.001	6.776 (3.988-11.479)	< 0.001
Positive	0				0
Negative	23 (23.7)				24 (24.7)
Histologic grade		0.023	1.594 (0.994-2.554)	0.053		0.026	1.294 (0.830-2.017)	0.256
Well/moderate	20 (21.5)				21 (22.6)
poor					3 (8.1)
Perineural invasion		0.211				0.417
Present	14 (22.6)				15 (24.2)
Absent	9 (13.2)				9 (13.2)
T stage		0.004	1.582 (0.390-6.415)	0.521		0.001	2.399 (0.734-7.836)	0.147
T1/2	22 (22)				21 (21)
T3/4	2 (6.7)				2 (6.7)
N stage		< 0.001	2.902 (1.132-7.439)	0.027		< 0.001	2.827 (1.243-6.429)	0.013
N0	22 (27.2)				23 (28.4)
N1	1 (2.0)				1 (2.0)
AJCC stage		< 0.001	0.673 (0.289-1.567)	0.358		< 0.001	0.844 (0.351-2.028)	0.704
Stage I/II	20 (32.8)				21 (34.4)
Stage III/IV	3 (4.9)				3 (4.9)
Lymphovascular invasion		< 0.001	2.799 (1.588-4.935)	< 0.001		< 0.001	2.908 (1.712-4.938)	< 0.001
Present	0					0.000
Absent	23 (22.8)				24 (24.8)
Tumor size (mm)		< 0.001	1.942 (1.176-3.209)	0.010		< 0.001	1.739 (1.101-2.745)	0.018
≤ 30	15 (20)				16 (21.3)
> 30	8 (14.5)				8 (14.5)
Portal vein invasion		0.003	1.759 (0.534-5.800)	0.353		0.002	1.130 (0.408-3.127)	0.815
Present	1 (4.2)				1 (4.2)
Absent	22 (20.8)				23 (21.7)
Hepatic invasion		0.008	1.499 (0.612-3.668)	0.376		0.013	1.196 (0.526-2.719)	0.669
Present	1 (9.1)	1 (9.1)			1 (9.1)
Absent	22 (18.5)	22 (18.5)			23 (19.3)
Transfusion		0.445				0.199
Yes	11 (16.4)				11 (16.4)
No	12 (19.0)				13 (20.6)

Table 3 Logistic regression analysis for factors associated with lymphovascular invasion

Variable	Lymphovascualr invasion (+), n = 29	Lymphovascualr invasion (-), n = 113	Univariate analysis (P value)	OR (95%CI)	Multivariate analysis (P value)
AJCC stage			0.063	0.223 (0.026-1.927)	0.173
I/II	8	27
III/IV	21	86
Tumor diameter (mm)			0.001	3.258 (1.288-8.236)	0.013
≤ 30	10	77
> 30	19	36
N stage			< 0.001	3.312 (1.338-8.198)	0.026
N0	10	79
N1	19	34