Background/Objectives. Lymph Node Ratio (LNR) is increasingly recognized as an important prognostic factor in various cancer types, with the potential to enhance patient stratification for intrahepatic (ICC) and extrahepatic (ECC) cholangiocarcinoma. The study aimed to assess the impact of LNR on survival in surgically resected patients with ICC and ECC.Methods. This was a retrospective analysis of National Cancer Database (2004–2020) included ICC and ECC (excluding distal bile duct) patients who underwent primary site resection with adequate lymphadenectomy (≥4 LNs excised). Exclusions comprised age < 18 years, distant metastasis, or incomplete key data. LNR was calculated as the ratio of positive LNs to total examined LNs. Survival probabilities were estimated using Kaplan–Meier analysis and Cox regression.Results. The inclusion criteria were met by 954 patients with ICC and 1607 patients with ECC. In patients with ICC, the median OS time was 62.7 months in LNR0 group, 40.8 months in LNR < 30%, and 25.2 months in LNR ≥ 30% (p< 0.001). In ICC, 3-year OS was 69.3%, 54.6%, and 34% for LNR 0, LNR < 30%, and LNR ≥ 30%, respectively (p< 0.05). When adjusted for age, sex, Charlson–Deyo score, histology, surgical margins, chemo- and radiotherapy using Cox regression, LNR < 30% and LNR ≥ 30% were associated with worse OS in patients with ICC (HR 2.1 (95% CI 1.6–2.7) and HR 2.94 (95% CI 2.3–3.8)) and ECC (HR 2.1 (95% CI 1.8–2.5) and HR 3 (95% CI 2.4–3.7)).Conclusions. It is well-known that LN-negative patients have significantly better survival than LN-positive patients with ICC and ECC. This study strongly demonstrates that survival prognosis can be further stratified based on LNR for ICC and ECC patients and that it is not simply a binary factor.
背景/目的。淋巴结比率（LNR）日益被认为是多种癌症类型的重要预后因素，在肝内胆管癌（ICC）和肝外胆管癌（ECC）中具有增强患者分层的潜力。本研究旨在评估LNR对手术切除的ICC和ECC患者生存的影响。 方法。本研究为一项回顾性分析，数据来源于美国国家癌症数据库（2004–2020年），纳入了接受原发部位切除并进行了充分淋巴结清扫（切除淋巴结≥4枚）的ICC和ECC（排除远端胆管癌）患者。排除标准包括年龄<18岁、远处转移或关键数据不完整。LNR计算为阳性淋巴结数与总检查淋巴结数之比。使用Kaplan–Meier分析和Cox回归估计生存概率。 结果。共有954例ICC患者和1607例ECC患者符合纳入标准。在ICC患者中，LNR0组的中位总生存时间为62.7个月，LNR < 30%组为40.8个月，LNR ≥ 30%组为25.2个月（p< 0.001）。ICC患者中，LNR 0、LNR < 30%和LNR ≥ 30%组的3年总生存率分别为69.3%、54.6%和34%（p< 0.05）。通过Cox回归调整年龄、性别、Charlson–Deyo评分、组织学类型、手术切缘、化疗和放疗后，LNR < 30%和LNR ≥ 30%与ICC患者（HR 2.1 (95% CI 1.6–2.7) 和 HR 2.94 (95% CI 2.3–3.8)）及ECC患者（HR 2.1 (95% CI 1.8–2.5) 和 HR 3 (95% CI 2.4–3.7)）更差的总生存率相关。 结论。众所周知，淋巴结阴性ICC和ECC患者的生存率显著优于淋巴结阳性患者。本研究有力地证明，对于ICC和ECC患者，生存预后可以基于LNR进行进一步分层，而LNR并非简单的二元因素。
Prognostic Significance of Lymph Node Ratio in Intrahepatic and Extrahepatic Cholangiocarcinomas
肿瘤(癌症)患者之家