A new three-tier nodal classification improves survival predictions for intrahepatic cholangiocarcinoma patients post-surgery.

• Median overall survival drops significantly: 55.3 months (n0) to 19.0 months (n2) (p < 0.001).
• Node-positive patients (n1, n2) face worse outcomes (HR 2.01 and HR 2.59, respectively) compared to node-negative (n0).

Use this refined staging to guide treatment decisions, especially for chemotherapy selection in node-positive cases.

• Adjuvant chemotherapy offers node-positive patients an additional survival benefit (5.2 months for n1, 4.0 months for n2) versus 1.4 months for node-negative patients.