Prognostic Implications of Lymph Node Status for Patients With Gallbladder Cancer: A Multi-Institutional Study

Abstract

Background Although the American Joint Committee on Cancer (AJCC) classification is the most accepted lymph node (LN) staging system for gallbladder adenocarcinoma (GBA), other LN prognostic schemes have been proposed. This study sought to define the performance of the AJCC LN staging system relative to the number of metastatic LNs (NMLN), the log odds of metastatic LN (LODDS), and the LN ratio (LNR). Methods Patients who underwent curative-intent resection for GBA between 2000 and 2015 were identified from a multi-institutional database. The prognostic performance of various LN staging systems was compared by Harrell’s C and the Akaike information criterion (AIC). Results Altogether, 214 patients with a median age of 66.7 years (interquartile range [IQR] 56.5–73.1) were identified. A total of 1334 LNs were retrieved, with a median of 4 (IQR 2–8) LNs per patient. Patients with LN metastasis had an increased risk of death (hazard ratio [HR] 1.87; 95 % confidence interval [CI] 1.24–2.82; P = 0.003) and recurrence (HR 2.28; 95 % CI 1.37–3.80; P = 0.002). In the entire cohort, LNR, analyzed as either a continuous scale (C-index, 0.603; AIC, 803.5) or a discrete scale (C-index, 0.609; AIC, 802.2), provided better prognostic discrimination. Among the patients with four or more LNs examined, LODDS (C-index, 0.621; AIC, 363.8) had the best performance versus LNR (C-index, 0.615; AIC, 368.7), AJCC LN staging system (C-index, 0.601; AIC, 373.4), and NMLN (C-index, 0.613; AIC, 369.5). Conclusions Both LODDS and LNR performed better than the AJCC LN staging system. Among the patients who had four or more LNs examined, LODDS performed better than LNR. Both LODDS and LNR should be incorporated into the AJCC LN staging system for GBA.

Systematic review of management of incidental gallbladder cancer after cholecystectomy

“…A number of factors are associated with outcome in incidental gallbladder cancer. Among the most important is the ability to achieve an R0 resection, whereas both a higher T category and the presence of lymph node metastasis are strong predictors of poor survival. Several attempts at refining prognostication have been entertained, with a Gallbladder Cancer Predictive Risk (GBPR) score developed from a multicentre series of incidental gallbladder cancers.…”

The optimal number of lymph nodes to evaluate among patients undergoing surgery for gallbladder cancer: Correlating the number of nodes removed with survival in 6531 patients

“…Several other LN staging schemas have been proposed to evaluate the impact of TLNC and N1 disease on long‐term outcomes. In fact, our own group previously demonstrated that LODDS performed better than the AJCC LN staging system in terms of prognostic discrimination among patient with GBC . Other authors have advocated that the minimum number of LN resected to identify metastatic LNs and, thus properly stage the disease, could be derived from the LODDS distribution .…”

“…own group previously demonstrated that LODDS performed better than the AJCC LN staging system in terms of prognostic discrimination among patient with GBC. 24 Other authors have advocated that the minimum number of LN resected to identify metastatic LNs and, thus properly stage the disease, could be derived from the LODDS distribution. 17 To this point, we compared results from the machinelearning approach with the LODDS approach to identify the optimal range of LNs to be evaluated.…”

The prognostic value of lymph node ratio and log odds of positive lymph nodes in patients with lung adenocarcinoma

“…[3][4][5][6][7][8][9] Moreover, log odds ratio (LODDS), defined as the log of the ratio between the number of positive lymph nodes (PLNs) and the number of negative lymph nodes, has been proved effective in predicting the prognosis of patients with head and neck, breast, gallbladder, gastric, and colorectal cancers. [10][11][12][13][14] Whether LODDS can be used as a prognostic index of nonÀsmall cell lung cancer, however, is still unclear.…”