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Micro-lymphatic invasion impact prognosis of intrahepatic cholangiocarcinoma independent of lymph node metastasis and

Chaoqun Wang¹, Ying Zhu¹, Haoting Sun¹

¹Hepatobiliary Surgery Center, Department of General Surgery, Huashan Hospital,& Cancer Metastasis Institute, Fudan University, Shanghai, 200040, China.

European Journal of Surgical Oncology : the Journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology

|August 20, 2025

Summary

Micro-lymphatic invasion (MLI) is a critical independent prognostic factor in intrahepatic cholangiocarcinoma (ICC). Incorporating MLI assessment improves survival predictions beyond lymph node metastasis (LNM) and micro-vascular invasion (MVI).

Keywords:

Intrahepatic cholangiocarcinoma Micro-lymphatic invasion Prognosis

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Area of Science:

Oncology
Surgical Pathology
Cancer Prognostics

Background:

Intrahepatic cholangiocarcinoma (ICC) prognosis is complex.
Evaluating micro-lymphatic invasion (MLI) independently of lymph node metastasis (LNM) and micro-vascular invasion (MVI) is crucial.

Purpose of the Study:

To determine the prognostic significance of MLI in ICC patients.
To assess MLI's independent predictive value for survival outcomes.

Main Methods:

Retrospective cohort study of 137 ICC patients undergoing curative resection.
Immunohistochemical staining (D2-40, α-SMA, CD34, CK19) for MLI and MVI assessment.
Comparison of recurrence-free survival (RFS) and overall survival (OS) based on invasion status.

Main Results:

MLI was significantly associated with reduced OS and RFS, independent of LNM.
MLI status predicted survival outcomes similarly to LNM.
Multivariate analysis identified MLI as an independent prognostic factor for both OS and RFS.

Conclusions:

MLI is a critical independent prognostic marker in ICC.
Prognostic evaluations for ICC should incorporate MLI assessment.
Understanding MLI improves prediction of patient outcomes.