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Optimal assessment of lymph node status in gallbladder cancer

Authors
 S.H. Kim  ;  J.U. Chong  ;  J.H. Lim  ;  G.H. Choi  ;  C.M. Kang  ;  J.S. Choi  ;  W.J. Lee  ;  K.S. Kim 
Citation
 European Journal of Surgical Oncology, Vol.42(2) : 205-210, 2016 
Journal Title
 European Journal of Surgical Oncology 
ISSN
 0748-7983 
Issue Date
2016
MeSH
Adult ; Aged ; Cholecystectomy ; Combined Modality Therapy ; Female ; Gallbladder Neoplasms/pathology* ; Gallbladder Neoplasms/therapy* ; Humans ; Lymph Node Excision* ; Lymph Nodes/pathology* ; Lymph Nodes/surgery ; Lymphatic Metastasis ; Male ; Middle Aged ; Neoplasm Invasiveness ; Neoplasm Staging ; Prognosis ; Retrospective Studies ; Survival Rate
Keywords
Gallbladder cancer ; Lymph node ; Overall survival
Abstract
BACKGROUND: Lymph node (LN) metastasis is an important prognostic factor in gallbladder cancer (GBCA). LN status has been adopted as a critical element of staging systems. However, the influence of total lymph node count (TLNC) remains unclear. We determined the optimal minimum TLNC and compared the prognostic significance of LN status indices in GBCA. METHODS: We retrospectively reviewed medical records of 128 patients with T2 or greater GBCA who underwent LN dissection. We analyzed overall survival (OS) and relevance of the number of metastatic LNs, ratio of metastatic LNs to retrieved LNs (LNR), and TLNC in predicting OS. RESULTS: The median OS durations were 120, 35, and 18 months in T2, T3, and T4 GBCA. Five-year OS rates were 73%, 43%, and 0% in T2, T3, and T4 GBCA. LN status did not significantly impact OS in T2 or T4 GBCA. However, all LN indices were significantly correlated with OS in T3 GBCA. Furthermore, multivariate analysis revealed that a metastatic LN count of more than four and a TLNC of more than eight were independent prognostic factors of OS in T3 GBCA. CONCLUSIONS: TLNC and the number of positive LNs may be more important prognostic factors than LNR in T3 GBCA. Additionally, accurate staging may not be achieved in cases of T3 GBCA if the total number of retrieved LNs is less than eight. Thus, to ensure proper staging, we recommend that surgeons harvest more than eight LNs in patients with T3 GBCA.
Full Text
http://www.sciencedirect.com/science/article/pii/S0748798315008367
DOI
10.1016/j.ejso.2015.10.013
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
Yonsei Authors
강창무(Kang, Chang Moo) ORCID logo https://orcid.org/0000-0002-5382-4658
김경식(Kim, Kyung Sik) ORCID logo https://orcid.org/0000-0001-9498-284X
이우정(Lee, Woo Jung) ORCID logo https://orcid.org/0000-0001-9273-261X
임진홍(Lim, Jin Hong)
정재욱(Chong, Jae Uk)
최기홍(Choi, Gi Hong) ORCID logo https://orcid.org/0000-0002-1593-3773
최진섭(Choi, Jin Sub)
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URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/146717
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