Neda Amini1, Yuhree Kim1, Ana Wilson1, Georgios Antonios Margonis1, Cecilia G Ethun2, George Poultsides3, Thuy Tran3, Kamran Idrees4, Chelsea A Isom4, Ryan C Fields5, Bradley Krasnick5, Sharon M Weber6, Ahmed Salem6, Robert C G Martin7, Charles Scoggins7, Perry Shen8, Harveshp D Mogal8, Carl Schmidt9, Eliza Beal9, Ioannis Hatzaras10, Rivfka Shenoy10, Shishir K Maithel2, Timothy M Pawlik11. 1. Division of Surgical Oncology, Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA. 2. Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, USA. 3. Department of Surgery, Stanford University Medical Center, Stanford, CA, USA. 4. Division of Surgical Oncology, Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA. 5. Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA. 6. Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA. 7. Division of Surgical Oncology, Department of Surgery, University of Louisville, Louisville, KY, USA. 8. Department of Surgery, Wake Forest University, Winston-Salem, NC, USA. 9. Division of Surgical Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA. 10. Department of Surgery, New York University, New York, NY, USA. 11. Division of Surgical Oncology, Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA. tpawlik1@jhmi.edu.
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.
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.
Authors: Hiromichi Ito; Kaori Ito; Michael D'Angelica; Mithat Gonen; David Klimstra; Peter Allen; Ronald P DeMatteo; Yuman Fong; Leslie H Blumgart; William R Jarnagin Journal: Ann Surg Date: 2011-08 Impact factor: 12.969
Authors: H Shimada; I Endo; Y Fujii; N Kamiya; H Masunari; O Kunihiro; K Tanaka; K Misuta; S Togo Journal: Langenbecks Arch Surg Date: 2000-12 Impact factor: 3.445
Authors: Yuman Fong; Lawrence Wagman; Mithat Gonen; James Crawford; William Reed; Richard Swanson; Charlie Pan; Jamie Ritchey; Andrew Stewart; Michael Choti Journal: Ann Surg Date: 2006-06 Impact factor: 12.969
Authors: Tak Geun Oh; Moon Jae Chung; Seungmin Bang; Seung Woo Park; Jae Bok Chung; Si Young Song; Gi Hong Choi; Kyung Sik Kim; Woo Jung Lee; Jeong Youp Park Journal: J Gastrointest Surg Date: 2013-01-09 Impact factor: 3.452
Authors: Woohyung Lee; Chi-Young Jeong; Young Hoon Kim; Young Hoon Roh; Myung Hee Yoon; Hyung Il Seo; Jeong-Ik Park; Bo-Hyun Jung; Dong Hoon Shin; Young Il Choi; Je Ho Ryu; Kwang Ho Yang; Chang Soo Choi; Yo-Han Park; Yang Won Nah; Soon-Chan Hong Journal: Langenbecks Arch Surg Date: 2019-08-14 Impact factor: 3.445
Authors: Guoshu Bi; Tao Lu; Guangyu Yao; Yunyi Bian; Mengnan Zhao; Yiwei Huang; Yi Zhang; Liang Xue; Cheng Zhan; Hong Fan Journal: Cancer Manag Res Date: 2019-11-06 Impact factor: 3.989