Optimal Lymph Node Staging System in Evaluating Prognosis of Gallbladder Carcinoma: A Multi-institutional Study

Overview

Journal Ann Surg Oncol

Publisher Springer

Specialty Oncology

Date 2021 Sep 17

PMID 34532819

Citations 9

Authors

Chen Chen

Zhang Rui

Wu Yuhan

Zhang Yongjie

Qiu Yinghe

Yang Ning

Song Tianqiang

Lou Jianying

Li Jiangtao

Mao Xianhai

Li Shengping

Si Shubin

Cai Zhiqiang

Tang Zhaohui

Geng Zhimin

Affiliations

Soon will be listed here.

Abstract

Background: Lymph node (LN) involvement is a critical prognostic factor in patients with gallbladder carcinoma (GBC). Controversy exists regarding optimal categorization of nodal metastasis status, including anatomical location of positive nodes (AJCC 7th N staging), number of metastatic lymph nodes (NMLN), log odds of metastatic LNs (LODDS), and lymph node ratio (LNR).

Methods: Patients who underwent curative-intent resection for GBC from six Chinese tertiary hospitals between 2008 and 2013 were analyzed retrospectively. The relative discriminative abilities of the different LN staging systems were assessed by different models including the tree-augmented naïve Bayesian (TAN) model, Cox proportional hazards regression model, and binary logistic regression model.

Results: A total of 226 patients were involved in this cohort. Based on the TAN model and composite importance measures, the most important factor affecting the prognosis in the different LN staging systems was NMLN. Among the four TAN models which were built with 4 metastatic LN markers and baseline variables, the accuracy of the NMLN-based prognostic model was 88.15%, higher than 7th N staging (86.44%), LNR (87.34%), and LODDS (85.19%). The Cox model based on NMLN (C-index: 0.763, AIC: 1371.62) had a higher fitness than the others (7th N staging C-index: 0.756, AIC: 1375.51; LNR C-index: 0.759, AIC: 1378.82; LODDS C-index 0.748, AIC: 1390.99). The AUCs of different staging binary logistic regression models were NMLN (0.872), LNR (0.872), 7th N staging (0.869) and LODDS (0.856), respectively.

Conclusions: NMLN was the optimal LN staging system in evaluating prognosis of GBC.

Citing Articles

Risk factors and survival prediction model establishment for prognosis in patients with radical resection of gallbladder cancer.

Li X, Ma T, Li T World J Gastrointest Surg. 2024; 16(10):3239-3252.

PMID: 39575289 PMC: 11577418. DOI: 10.4240/wjgs.v16.i10.3239.

Advantage of Log Odds of Metastatic Lymph Nodes After Curative-Intent Resection of Gallbladder Cancer.

Catalano G, Alaimo L, Chatzipanagiotou O, Ruzzenente A, Aucejo F, Marques H Ann Surg Oncol. 2024; 32(3):1742-1751.

PMID: 39542966 DOI: 10.1245/s10434-024-16492-2.

Lymph node involvement is associated with overall survival for elderly patients with non-metastatic gallbladder adenocarcinoma.

Huang J, Qiu Y, Bai X, He X Front Surg. 2024; 11:1414870.

PMID: 39108285 PMC: 11300228. DOI: 10.3389/fsurg.2024.1414870.

Fatty Acid Binding Protein 1 is an Independent Prognostic Biomarker for Gallbladder Cancer with Direct Hepatic Invasion.

Qiu S, Liu Z, Hu J, Wang Z, Yue Z, Jia Z Int J Med Sci. 2024; 21(5):862-873.

PMID: 38617005 PMC: 11008480. DOI: 10.7150/ijms.93413.

Metastatic lymph node ratio as an important prognostic factor in advanced gallbladder carcinoma with at least 6 lymph nodes retrieved.

Wang J, Liu F, Ma W, Hu H, Li F Langenbecks Arch Surg. 2023; 408(1):382.

PMID: 37770780 PMC: 10539180. DOI: 10.1007/s00423-023-03119-5.

References

Hundal R, Shaffer E . Gallbladder cancer: epidemiology and outcome. Clin Epidemiol. 2014; 6:99-109. PMC: 3952897. DOI: 10.2147/CLEP.S37357. View

Hueman M, Vollmer Jr C, Pawlik T . Evolving treatment strategies for gallbladder cancer. Ann Surg Oncol. 2009; 16(8):2101-15. DOI: 10.1245/s10434-009-0538-x. View

Misra S, Chaturvedi A, Misra N, Sharma I . Carcinoma of the gallbladder. Lancet Oncol. 2003; 4(3):167-76. DOI: 10.1016/s1470-2045(03)01021-0. View

Arroyo G, Gentile A, Parada L . Gallbladder cancer: South American experience. Chin Clin Oncol. 2016; 5(5):67. DOI: 10.21037/cco.2016.10.01. View

Wistuba I, Gazdar A . Gallbladder cancer: lessons from a rare tumour. Nat Rev Cancer. 2004; 4(9):695-706. DOI: 10.1038/nrc1429. View

Mantripragada K, Hamid F, Shafqat H, Olszewski A . Adjuvant Therapy for Resected Gallbladder Cancer: Analysis of the National Cancer Data Base. J Natl Cancer Inst. 2016; 109(2). DOI: 10.1093/jnci/djw202. View

Mitin T, Enestvedt C, Jemal A, Sineshaw H . Limited Use of Adjuvant Therapy in Patients With Resected Gallbladder Cancer Despite a Strong Association With Survival. J Natl Cancer Inst. 2017; 109(7). DOI: 10.1093/jnci/djw324. View

Suzuki E, Bridgewater J . Adjuvant therapy for resected gallbladder cancer. Chin Clin Oncol. 2019; 8(4):39. DOI: 10.21037/cco.2019.07.02. View

Yamamoto T, Horiguchi A, Ito M, Nagata H, Ichii H, Ricordi C . Quality control for clinical islet transplantation: organ procurement and preservation, the islet processing facility, isolation, and potency tests. J Hepatobiliary Pancreat Surg. 2009; 16(2):131-6. DOI: 10.1007/s00534-009-0064-z. View

10.

Allen P, DAngelica M, Gonen M, Jaques D, Coit D, Jarnagin W . A selective approach to the resection of cystic lesions of the pancreas: results from 539 consecutive patients. Ann Surg. 2006; 244(4):572-82. PMC: 1856565. DOI: 10.1097/01.sla.0000237652.84466.54. View

11.

Shirai Y, Wakai T, Hatakeyama K . Radical lymph node dissection for gallbladder cancer: indications and limitations. Surg Oncol Clin N Am. 2007; 16(1):221-32. DOI: 10.1016/j.soc.2006.10.011. View

12.

Chijiiwa K, Imamura N, Ohuchida J, Hiyoshi M, Nagano M, Otani K . Prospective randomized controlled study of gastric emptying assessed by (13)C-acetate breath test after pylorus-preserving pancreaticoduodenectomy: comparison between antecolic and vertical retrocolic duodenojejunostomy. J Hepatobiliary Pancreat Surg. 2008; 16(1):49-55. DOI: 10.1007/s00534-008-0004-3. View

13.

Sun H, Yu X, Wu W, Chen J, Shi M, Zheng L . GLUT1 and ASCT2 as Predictors for Prognosis of Hepatocellular Carcinoma. PLoS One. 2016; 11(12):e0168907. PMC: 5201247. DOI: 10.1371/journal.pone.0168907. View

14.

Edge S, Compton C . The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol. 2010; 17(6):1471-4. DOI: 10.1245/s10434-010-0985-4. View

15.

Shirai Y, Sakata J, Wakai T, Ohashi T, Ajioka Y, Hatakeyama K . Assessment of lymph node status in gallbladder cancer: location, number, or ratio of positive nodes. World J Surg Oncol. 2012; 10:87. PMC: 3532237. DOI: 10.1186/1477-7819-10-87. View

16.

Birnbaum D, Vigano L, Russolillo N, Langella S, Ferrero A, Capussotti L . Lymph node metastases in patients undergoing surgery for a gallbladder cancer. Extension of the lymph node dissection and prognostic value of the lymph node ratio. Ann Surg Oncol. 2014; 22(3):811-8. DOI: 10.1245/s10434-014-4044-4. View

17.

Sakata J, Shirai Y, Wakai T, Ajioka Y, Hatakeyama K . Number of positive lymph nodes independently determines the prognosis after resection in patients with gallbladder carcinoma. Ann Surg Oncol. 2010; 17(7):1831-40. DOI: 10.1245/s10434-009-0899-1. View

18.

Margonis G, Sasaki K, Andreatos N, Kim Y, Merath K, Wagner D . KRAS Mutation Status Dictates Optimal Surgical Margin Width in Patients Undergoing Resection of Colorectal Liver Metastases. Ann Surg Oncol. 2016; 24(1):264-271. DOI: 10.1245/s10434-016-5609-1. View

19.

Amini B, Jessop A, Ganeshan D, Tseng W, Madewell J . Contemporary imaging of soft tissue sarcomas. J Surg Oncol. 2014; 111(5):496-503. DOI: 10.1002/jso.23801. View

20.

Geng Z, Cai Z, Zhang Z, Tang Z, Xue F, Chen C . Estimating survival benefit of adjuvant therapy based on a Bayesian network prediction model in curatively resected advanced gallbladder adenocarcinoma. World J Gastroenterol. 2019; 25(37):5655-5666. PMC: 6785523. DOI: 10.3748/wjg.v25.i37.5655. View