A Chinese team has found that for patients undergoing curative resection for hilar cholangiocarcinoma (HCCA), log odds of metastatic lymph nodes (LODDS) is the best of 4  lymph node staging systems with which to predict patient survival. 

The study, which appeared in the Journal of Gastrointestinal Surgery, retrospectively compared commonly employed lymph node (LN) staging systems in terms of their ability to predict overall survival (OS) and recurrence-free survival (RFS) among 229 patients undergoing radical surgery for HCCA.

LN metastasis is known to be a significant prognostic indicator for patients with HCCA, as is the case for most tumor types. A variety of LN staging systems are in use—including the American Joint Committee on Cancer (AJCC), the number of metastatic LNs (MLN), the ratio of LN (LNR), and LODDS—and the best system to predict OS and RFS among patients with HCCA has been a subject of debate. 

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The authors note, “Lymph node staging is complex because it involves lymph node metastasis locations as well as the number of metastatic nodes, along with the need to minimize the number of lymph note examinations to reduce trauma to the patient.”

Read more about the prognosis of cholangiocarcinoma

The AJCC LN staging system considers the number of metastatic areas, but it does not include the number of metastatic LNs. The number of metastatic LNs, on which LODDS is based, is a factor other authors have considered to be essential to accurately evaluating the prognosis of patients with gastrointestinal tumors.

The research team employed receiver operating characteristics (ROC) and area under the ROC curve (AUC) to compare the prognostic ability of each LN staging method in terms of mortality and RFS of patients with HCCA undergoing radical surgery. Their results indicate that, in terms of 1-, 3-, and 5-year OS, the accuracy of LODDS was significantly greater than that of the other 3 LN staging systems assessed.

In addition to using the LODDS system, the team also noted the importance of proper dissection of LNs for accurate staging and selection of treatments for these patients.


Liu ZP, Zhang QY, Chen WY, et al. Evaluation of four lymph node classifications for the prediction of survival in hilar cholangiocarcinoma. J Gastrointest Surg. Published online January 1, 2022. doi:10.1007/s11605-021-05211-x