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World Journal of Surgical Oncology

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Open Access 01-12-2012 | Research

Assessment of lymph node status in gallbladder cancer: location, number, or ratio of positive nodes

Authors: Yoshio Shirai, Jun Sakata, Toshifumi Wakai, Taku Ohashi, Yoichi Ajioka, Katsuyoshi Hatakeyama

Published in: World Journal of Surgical Oncology | Issue 1/2012

Abstract

Background

Assessment of lymph node status is a critical issue in the surgical management of gallbladder cancer. The aim of this study was to compare the anatomical location of positive nodes, number of positive nodes, and lymph node ratio (LNR) as prognostic predictors in gallbladder cancer.

Methods

We conducted a retrospective analysis of 135 patients with gallbladder cancer who underwent a radical resection with regional lymphadenectomy. A total of 2,245 regional lymph nodes were retrieved (median, 14 per patient). The location of positive nodes was classified according to the AJCC staging manual (7th edition). ‘Optimal’ cutoff values were determined for the number of positive nodes and LNR based on maximal χ² scores calculated with the Cox proportional hazards regression model.

Results

Lymph node metastasis was found histologically in 59 (44%) patients. The ‘optimal’ cutoff values for the number of positive nodes and LNR were determined to be three nodes and 10%, respectively. Univariate analysis identified location of positive nodes (pN0, pN1, pN2; P < 0.001), number of positive nodes (0, 1 to 3, ≥4; P < 0.001), and LNR (0%, 0 to 10%, >10%; P < 0.001) as significant prognostic factors. Multivariate analysis identified number of positive nodes as an independent prognostic factor ( P = 0.004); however, location of positive nodes and LNR failed to remain as an independent variable.

Conclusions

The number of positive lymph nodes better predicts patient outcome after resection than either the location of positive lymph nodes or LNR in gallbladder cancer. Dividing the number of positive lymph nodes into three categories (0, 1 to 3, or ≥4) is valid for stratifying patients based on the prognosis after resection.

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Title: Assessment of lymph node status in gallbladder cancer: location, number, or ratio of positive nodes
Authors: Yoshio Shirai
Jun Sakata
Toshifumi Wakai
Taku Ohashi
Yoichi Ajioka
Katsuyoshi Hatakeyama
Publication date: 01-12-2012
Publisher: BioMed Central
Published in: World Journal of Surgical Oncology / Issue 1/2012
Electronic ISSN: 1477-7819
DOI: https://doi.org/10.1186/1477-7819-10-87

At a glance: The STEP trials

Springer Medicine

Assessment of lymph node status in gallbladder cancer: location, number, or ratio of positive nodes

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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