# Lymph Node Metastasis Around the Common Hepatic Artery Is Associated With Dismal Prognosis in Patients Undergoing Resection of Extrahepatic Cholangiocarcinoma

## TL;DR

Lymph node metastasis near the common hepatic artery in cholangiocarcinoma patients is strongly linked to poor survival outcomes.

## Contribution

Identifies common hepatic artery lymph node metastasis as a novel strong prognostic marker in extrahepatic cholangiocarcinoma.

## Key findings

- Patients with CHA lymph node metastasis had a 6.9% 5-year cancer-specific survival rate.
- CHA node metastasis had a hazard ratio of 3.34 for cancer-specific survival.
- CHA node status can be detected via imaging and may guide treatment strategies.

## Abstract

Lymph node (LN) metastasis in extrahepatic cholangiocarcinoma (eCCA) is associated with poor prognosis, but the impact of specific metastatic sites is unclear. This study investigated the clinical significance of LN metastasis around the common hepatic artery (N [CHA]) in eCCA.

A total of 291 patients who underwent curative resection for eCCA between 2002 and 2022 were retrospectively reviewed. Patients were classified as N1 (CHA), N1 (other, regional LN metastasis without CHA), or N0. Clinical characteristics and long‐term outcomes were compared. The short‐to‐long axis ratio (SLR) of CHA nodes on preoperative CT was evaluated for diagnostic value.

Of 291 patients, 164 had perihilar and 127 had distal cholangiocarcinoma. The N1 (CHA), N1 (other), and N0 groups included 33, 103, and 155 patients, respectively. Five‐year cancer‐specific survival (CSS) rates were 6.9% (N1 [CHA]), 24.7% (N1 [other]), and 60.3% (N0). N1 (CHA) and N1 (other) had CSS hazard ratios of 3.34 and 1.86, respectively (p < 0.01). The area under the receiver operating characteristics curve for SLR in predicting N1 (CHA) was 0.779.

N1 (CHA) is a strong negative prognostic factor in eCCA. CHA node status may serve as a useful imaging‐based marker of biological resectability.

Kiritani and colleagues identified lymph node metastasis around the common hepatic artery as a powerful independent predictor of poor survival in extrahepatic cholangiocarcinoma. Readily detectable on imaging and accessible during surgery, common hepatic artery node status provides a practical biomarker to refine biological resectability and guide multimodal treatment strategies.