Radical lymph node dissection and assessment: Impact on gallbladder cancer prognosis

Liu, Guijie; Li, Xuehua; Chen, Yanxin; Sun, Haiqing; Zhao, Guangtao; Hu, Sanyuan

doi:10.3748/wjg.v19.i31.5150

Cited by 68 publications

(61 citation statements)

References 33 publications

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“…Its relevance for survival and staging is recognized and allows to differentiate standard lymphadenectomy (confined to the hepatoduodenal ligament) from extended lymphadenectomy (celiac trunk, interaorto-caval space, etc. ), with improved survival in the latter (24,25). In our series, regional lymphadenectomy was performed in all patients undergoing an extended cholecystectomy.…”

Section: Discussionmentioning

confidence: 99%

A retrospective analysis of patients with gallbladder cancer: surgical treatment and survival according to tumor stage

Alonso¹,

Marcacuzco²,

Nutu³

et al. 2018

Rev Esp Enferm Dig

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Section: Discussionmentioning

confidence: 99%

A retrospective analysis of patients with gallbladder cancer: surgical treatment and survival according to tumor stage

Alonso¹,

Marcacuzco²,

Nutu³

et al. 2018

Rev Esp Enferm Dig

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“…7 Lymph node status has been conventionally described in three ways: location of the metastatic LN, number of metastatic LNs (NMLN), and ratio of metastatic LNs to the number of retrieved LNs (LNR). 8–11 The American Joint Committee on Cancer (AJCC) staging system, which uses the tumor node metastasis (TNM) classification, defines LN status based on the location of metastatic LN. 9 Other studies have suggested that NMLN and LNR are more prognostic than the location of metastatic LN.…”

mentioning

confidence: 99%

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

et al. 2016

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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.

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“…As one of the strongest predictors, the N category was classified into N1 (hilar nodes) and N2 (other regional nodes) based on the location of lymph node metastasis in the 7th edition of the UICC TNM classification (20); however, the number of lymph nodes involved in metastasis has been reported to be a vital factor for clinicians to make predictions regarding the long-term survival of patients with GBC (17,25,26). In the latest 8th edition of the UICC staging manual, N1 was defined as metastases to 1–3 regional nodes, and N2 was defined as metastases to ≥4 regional nodes.…”

Section: Discussionmentioning

confidence: 99%

Prognostic validation of the updated 8th edition Tumor‑Node‑Metastasis classification by the Union for International Cancer Control: Survival analyses of 307 patients with surgically treated gallbladder carcinoma

et al. 2018

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In December 2016, the Union for International Cancer Control (UICC) published the 8th edition of the Tumor-Node-Metastasis (TNM) classification of malignant tumors, including a number of vital changes in the definitions of the T2 category, the N category and the stages of gallbladder cancer (GBC). The clinical value of this newly updated classification in patients with surgically treated GBC has not been rigorously validated. The present study aimed to analyze the prognosis of patients with GBC in a high-volume surgical unit, and to validate the prognostic value of the new UICC TNM classification, particularly the main changes in the stages of GBC. Data from 307 patients who were surgically treated and histopathologically diagnosed with GBC between January 2011 and July 2016 in The West China Hospital (Chengdu, Sichuan, China) were retrospectively collected and analyzed. The new UICC criteria distributed 32, 60, 99 and 116 eligible patients in stages I, II, III and IV, respectively. The differences in overall survival time between each stage (I–IV) demonstrated statistical significance (P<0.05). As a result of the main change of this classification, the novel definitions of T2a and T2b effectively stratified the prognosis of patients with T2 GBC (P<0.001). Furthermore, patients with stage IIa tumors also obtained significantly improved overall survival time compared with patients with stage IIb tumors (P=0.04), whereas the comparison between patients with stage IIb and IIIa tumors did not present any notable difference (P=0.20). Additionally, the new N category stratified the survival of the patients effectively (P<0.001). Together with curative resection, this latest classification was indicated to be an independent predictor of survival via multivariate analysis (hazard ratio, 6.25; 95% confidence interval, 3.81–10.26; P<0.001). In conclusion, the newly updated UICC TNM classification could effectively reflect the clinical outcome of patients with surgically treated GBC. Furthermore, tumor location could predict the survival of surgically treated T2 GBC. The novel classification of the N category by the number of lymph nodes involved was also demonstrated to be valid.

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Radical lymph node dissection and assessment: Impact on gallbladder cancer prognosis

Abstract: Both TLNC and LNR are strong predictors of outcome after curative resection for GBC. The retrieval and examination of at least 6 nodes can influence staging quality and DSS, especially in node-positive patients.

Cited by 68 publications

References 33 publications

A retrospective analysis of patients with gallbladder cancer: surgical treatment and survival according to tumor stage

A retrospective analysis of patients with gallbladder cancer: surgical treatment and survival according to tumor stage

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

Prognostic validation of the updated 8th edition Tumor‑Node‑Metastasis classification by the Union for International Cancer Control: Survival analyses of 307 patients with surgically treated gallbladder carcinoma

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