The modified classification of positive lymph nodes in intrahepatic cholangiocarcinoma (iCCA) could accurately stratify the N1 stage patients in the 8th TNM staging system into 2 groups that have significantly different overall survival, a new study in Cancer Cell International found.

The development of the nomogram offers new evidence to assist in managing postoperative iCCA patients precisely, the authors of the study wrote. 

The current classification of lymph nodes in the 8th TNM of iCCA is still necessary and could further improve prognostic capacity.

Continue Reading

In order to explore the optimal positive lymph nodes cutoff value that could predict survival in iCCA patients and establish a prognostic nomogram, a team of researchers from China analyzed 292 patients with iCCA.

Read more about the prognosis of CCA

The team retrospectively collected the clinical properties of the patients and also analyzed another 107 patients with the disease from a different institution for verification. 

They then used statistical analysis to determine the optimal cutoff value of positive lymph nodes and further establish the nomogram.

They reported that in patients who were graded into the N1 stage in the 8th TNM staging system, overall survival was significantly better for those with a positive lymph node between 1 and 3 compared to patients with more than 4 positive lymph nodes. 

The researchers also found a correlation between the new positive lymph node classification and adverse clinical characteristics such as micro invasion, lymph vessel invasion, satellite sites, and tumor size. 

The positive lymph node and examined lymph node were both independent prognostic factors for survival outcomes. They further showed a large contribution to the nomogram, which achieved a satisfied C-index of 0.813 for overall survival and 0.869 for progression-free survival in the first group of patients, and 0.787 for overall survival and 0.762 for progression-free survival in the second group of patients.

Based on these findings, the researchers concluded that “frequent monitoring should be taken in the patients with the higher score in this nomogram”.


Zhao C, Li X, Luo L, Chen C, He C. Modified staging system of positive lymph nodes based nomogram in intrahepatic cholangiocarcinoma. Cancer Cell Int. 2023;29;23(1):148. doi:10.1186/s12935-023-03005-6