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Risk factors for local lymph node metastasis in hepatic alveolar echinococcosis: a 10-year retrospective cohort study
Yierfan Yilihaer1, Yilizhati Aimaitijiang2, Ainiwaer Aikebaier1
1Department of Hepatobiliary and Echinococcosis Surgery, Digestive and Vascular Surgery Center, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.
Background:
Hepatic alveolar echinococcosis (HAE) is characterised by infiltrative growth and "cancer-like" biological behaviour. Although radical resection remains the standard treatment, the need for prophylactic lymph node dissection is still debated because preoperative identification of metastasis is difficult. This investigation assesses the risk factors associated with local lymph node metastasis in HAE.
Methods:
Clinical data were retrospectively reviewed for 623 patients with HAE admitted to our hospital between January 2012 and January 2022. Based on strict screening criteria, 191 patients who underwent radical hepatectomy were enrolled and divided into a local lymph node metastasis (LNM) group (n=55) and a non-local metastasis group (n=136) based on postoperative pathological findings. Univariate group-comparison tests (independent t-test, Mann-Whitney U test, and Chi-square test) were performed to compare baseline and lesion characteristics between the two groups, followed by multivariable logistic regression analysis.
Results:
Univariate group-comparison analyses revealed statistically significant differences between the two groups regarding sex (P = 0.004), age (P = 0.027), ethnicity (P = 0.001), concomitant distant organ metastasis (P<0.001), lesion location (P = 0.001), portal vein invasion (P = 0.016), direct bilirubin (P<0.001), and neutrophil percentage (P = 0.012). Multivariate analysis identified female sex (P = 0.004, OR = 2.941, 95% CI: 1.399-6.182), concomitant distant organ metastasis (P<0.001, OR = 5.522, 95% CI: 2.322-13.133), and bilobar lesion involvement (OR = 4.739, 95% CI: 2.129-10.548, P<0.001) as independent risk factors for local lymph node metastasis in HAE. The multivariable model demonstrated acceptable calibration (Hosmer-Lemeshow test, P = 0.143) and discrimination with an AUC of 0.771 (95% CI: 0.697-0.845).
Conclusions:
Female gender, concomitant distant organ metastasis, and lesions involving both hepatic lobes (bilobar involvement) are independent risk factors for local lymph node metastasis in HAE. For patients presenting with these factors, intraoperative prophylactic local lymph node dissection is suggested.