Optimal assessment of lymph node status in gallbladder cancer

Kim, S.H.; Chong, Jae Uk; Lim, Jin Hong; Choi, Gi Hong; Kang, Chang Moo; Choi, Jin Sub; Lee, Woo Jung

doi:10.1016/j.ejso.2015.10.013

Cited by 25 publications

(13 citation statements)

References 26 publications

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“…Laparoscopic lymph node dissection was performed for most patients diagnosed with malignancy after intraoperative frozen-section examination unless there were microscopic indications highly suggestive of Tis/T1a or serious comorbidity. In our series, a mean harvested lymph node count of 4±3 was achieved (range, 1-12), meeting the Western criteria of adequate lymphadenectomy (20,21) while failing to meet the more strict criteria reported from Korea (22). The overall 5-year survival rate was 68.8%.…”

Section: Discussionmentioning

confidence: 59%

“…The disease-specific actual survival rate of 22 patients whose postoperative follow-up period exceeded 5 years was 72.7% at 5 years, 52.5% of this cohort having stage T2 or T3 lesions. It is widely appreciated that extensive lymphadenectomy for GBC with lymph node metastasis exhibiting aggressive features and poor prognosis (21,23) cannot be justified for most patients (21). However, there is no reliable technique that can preoperatively distinguish patients with or without lymph node metastasis.…”

Section: Discussionmentioning

confidence: 99%

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Laparoscopic treatment for suspected gallbladder cancer confined to the wall: a 10-year study from a single institution

Zhang

Hou

et al. 2018

Chinese Journal of Cancer Research

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Section: Discussionmentioning

confidence: 59%

Section: Discussionmentioning

confidence: 99%

Laparoscopic treatment for suspected gallbladder cancer confined to the wall: a 10-year study from a single institution

Zhang

Hou

et al. 2018

Chinese Journal of Cancer Research

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“…Amini N et al (5) indicated that LNR performed better than LN location when used for GBC diagnosis, especially for patients with four or more LNs examined. Similarly, Kim SH et al (15) found that the number of positive LNs had a positive effect on prognostic performance compared to LNR in T3 GBC when the number of LNs examined was eight or more. These studies were conducted on small cohorts and did not compare the prognostic value of the indices when the number of LNs examined was fewer than six.…”

Section: Discussionmentioning

confidence: 87%

Lymph Node Ratio-Based Staging System for Gallbladder Cancer With Fewer Than Six Lymph Nodes Examined

Sun

Zhao

et al. 2020

Front. Oncol.

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Purpose: The 8th edition of the American Joint Committee on Cancer (AJCC) tumor-lymph node-metastasis (TNM) staging system for gallbladder cancer (GBC) recommended that at least six lymph nodes (LNs) should be examined. But most patients with GBC had fewer than six LNs resected. This study aimed to establish an alternative index for assessing the LN status during the staging system for GBC patients with fewer than six LNs retrieved. Patients and Methods: Patient data was extracted from the Surveillance, Epidemiology, and End Results (SEER) database (cases between 2004 and 2013). X-tile software was used to determine the optimal cutoff value for lymph node ratio (LNR) and a concordance index (C-index) was used to evaluate the discriminatory powers of the two staging systems. Results: The majority of GBC patients in our cohort (1353, 78.5%) had fewer than six LNs examined. Among patients with inadequate LN examination, the higher number of LNs examined correlated with a lower proportion of patients. Using the TNM staging system, the C-index for patients with fewer than six LNs and patients with six or more LNs screened were 0.636 and 0.704, respectively. Using the staging system based on LNR (TNrM), the C-index for patients with fewer than six LNs retrieved and patients with six or more LNs retrieved were 0.649 and 0.694, respectively. Similar results were observed in patients with gallbladder adenocarcinoma (GBA). Conclusion: TNrM might be superior to the 8th AJCC TNM staging system for stratifying GBC patients with fewer than six LNs examined, and it can complement TNM for more accurate risk stratification. Future prospective studies are needed to validate our findings.

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“…However, not all patients with regional LNM have uniformly poor outcomes after resection [27]. Some authors have found that high metastatic lymph node numbers [27, 28] or a high metastatic lymph node ratio [29] was associated with a dismal prognosis in patients with GBCa who had LNM. However, it is difficult to preoperatively evaluate these factors in patients with LNM.…”

Section: Discussionmentioning

confidence: 99%

Surgical Indication for Advanced Gallbladder Cancer Considering the Optimal Preoperative Carbohydrate Antigen 19-9 Cutoff Value

et al. 2020

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Background: Selecting patients who will benefit from resection among those with advanced gallbladder cancer (GBCa) having poor prognostic factors is difficult. Methods: One hundred twenty-one patients who underwent resection for stage II-IV GBCa and 19 unresected patients (unresectable group) were enrolled. The clinical impact of carbohydrate antigen 19-9 (CA19-9) and advanced surgical procedures for GBCa was evaluated. Results: The optimal CA19-9 cutoff value (based on the greatest difference in overall survival) was 250 U/mL. CA19-9 ≥250 U/mL was found to be an independent prognostic factor. Patients with CA19-9 <250 U/mL who developed jaundice (median survival time [MST], 49.1 months) or who required major hepatectomy (MST, 21.5 months) or pancreatoduodenectomy (PD; MST, 50.3 months) had a better prognosis than those with CA19-9 ≥250 U/mL who developed jaundice (MST, 16.1 months; p = 0.061) or who required major hepatectomy (MST, 9.2 months; p = 0.066) or PD (MST, 8.6 months; p = 0.025); their prognosis was comparable to that of the unresectable group (jaundice: p = 0.145, major hepatectomy: p = 0.292, PD: p = 0.756). Conclusions: Even if GBCa patients develop jaundice or require major hepatectomy, or combined PD, resection can be considered for those with CA19-9 <250 U/mL. However, surgical indication should be carefully determined in patients with CA19-9 ≥250 U/mL.

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Optimal assessment of lymph node status in gallbladder cancer

Cited by 25 publications

References 26 publications

Laparoscopic treatment for suspected gallbladder cancer confined to the wall: a 10-year study from a single institution

Laparoscopic treatment for suspected gallbladder cancer confined to the wall: a 10-year study from a single institution

Lymph Node Ratio-Based Staging System for Gallbladder Cancer With Fewer Than Six Lymph Nodes Examined

Surgical Indication for Advanced Gallbladder Cancer Considering the Optimal Preoperative Carbohydrate Antigen 19-9 Cutoff Value

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