Woohyung Lee1,2, Chi-Young Jeong1, Young Hoon Kim3, Young Hoon Roh3, Myung Hee Yoon4, Hyung Il Seo4, Jeong-Ik Park5, Bo-Hyun Jung5, Dong Hoon Shin6, Young Il Choi6, Je Ho Ryu7, Kwang Ho Yang7, Chang Soo Choi8, Yo-Han Park8, Yang Won Nah9, Soon-Chan Hong10. 1. Department of Surgery, Gyeongsang National University Hospital, Gyeongsang National University, College of Medicine, 79 Gangnam-ro, Jinju, 660-702, Republic of Korea. 2. Division of Hepato-Biliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Ulsan, Republic of Korea. 3. Department of Surgery, Dong-A University Hospital, Dong-A University, College of Medicine, Busan, Republic of Korea. 4. Department of Surgery, Biomedical Research Institute, Pusan National University Hospital, Pusan National University, College of Medicine, Busan, Republic of Korea. 5. Department of Surgery, Haeundae Paik Hospital, Inje University, College of Medicine, Busan, Republic of Korea. 6. Department of Surgery, Kosin University Gospel Hospital, Kosin University, College of Medicine, Busan, Republic of Korea. 7. Department of Surgery, Pusan University Yangsan Hospital, Pusan University, College of Medicine, Busan, Republic of Korea. 8. Department of Surgery, College of Medicine, Inje University, Busan Paik Hospital, Busan, Republic of Korea. 9. Department of Surgery, Ulsan University Hospital, Ulsan University, College of Medicine, Ulsan, Republic of Korea. 10. Department of Surgery, Gyeongsang National University Hospital, Gyeongsang National University, College of Medicine, 79 Gangnam-ro, Jinju, 660-702, Republic of Korea. hongsc@gnu.ac.kr.
Abstract
BACKGROUND: Although the current nodal staging system for gallbladder cancer (GBC) was changed based on the number of positive lymph nodes (PLN), it needs to be evaluated in various situations. METHODS: We reviewed the clinical data for 398 patients with resected GBC and compared nodal staging systems based on the number of PLNs, the positive/retrieved LN ratio (LNR), and the log odds of positive LN (LODDS). Prognostic performance was evaluated using the C-index. RESULTS: Subgroups were formed on the basis of an restricted cubic spline plot as follows: PLN 3 (PLN = 0, 1-2, ≥ 3); PLN 4 (PLN = 0, 1-3, ≥ 4); LNR (LNR = 0, 0-0.269, ≥ 0.27); and LODDS (LODDS < - 0.8, - 0.8-0, ≥ 0). The oncological outcome differed significantly between subgroups in each system. In all patients with GBC, PLN 4 (C-index 0.730) and PLN 3 (C-index 0.734) were the best prognostic discriminators of survival and recurrence, respectively. However, for retrieved LN (RLN) ≥ 6, LODDS was the best discriminator for survival (C-index 0.852). CONCLUSION: The nodal staging system based on PLN was the optimal prognostic discriminator in patients with RLN < 6, whereas the LODDS system is adequate for RLN ≥ 6. The following nodal staging system considers applying different systems according to the RLN.
BACKGROUND: Although the current nodal staging system for gallbladder cancer (GBC) was changed based on the number of positive lymph nodes (PLN), it needs to be evaluated in various situations. METHODS: We reviewed the clinical data for 398 patients with resected GBC and compared nodal staging systems based on the number of PLNs, the positive/retrieved LN ratio (LNR), and the log odds of positive LN (LODDS). Prognostic performance was evaluated using the C-index. RESULTS: Subgroups were formed on the basis of an restricted cubic spline plot as follows: PLN 3 (PLN = 0, 1-2, ≥ 3); PLN 4 (PLN = 0, 1-3, ≥ 4); LNR (LNR = 0, 0-0.269, ≥ 0.27); and LODDS (LODDS < - 0.8, - 0.8-0, ≥ 0). The oncological outcome differed significantly between subgroups in each system. In all patients with GBC, PLN 4 (C-index 0.730) and PLN 3 (C-index 0.734) were the best prognostic discriminators of survival and recurrence, respectively. However, for retrieved LN (RLN) ≥ 6, LODDS was the best discriminator for survival (C-index 0.852). CONCLUSION: The nodal staging system based on PLN was the optimal prognostic discriminator in patients with RLN < 6, whereas the LODDS system is adequate for RLN ≥ 6. The following nodal staging system considers applying different systems according to the RLN.
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: Katharina Cziupka; Lars Ivo Partecke; Lutz Mirow; Claus-Dieter Heidecke; Christian Emde; Wolfgang Hoffmann; Ulrike Siewert; Neeltje van den Berg; Wolfram von Bernstorff; Albrecht Stier Journal: Langenbecks Arch Surg Date: 2012-03-28 Impact factor: 3.445