Euroasian journal of hepato-gastroenterology

Register      Login

VOLUME 11 , ISSUE 1 ( January-June, 2021 ) > List of Articles

Original Article

Lymph Node Ratio is an Important Prognostic Factor in Curatively Resected Gallbladder Carcinoma, Especially in Node-positive Patients: An Experience from Endemic Region in a Developing Country

Shah Naveed, Hasina Qari, Cao M Thau, Pipit Burasakarn, Abdul W Mir, Brij Bhushan Panday

Citation Information : Naveed S, Qari H, Thau CM, Burasakarn P, Mir AW, Panday BB. Lymph Node Ratio is an Important Prognostic Factor in Curatively Resected Gallbladder Carcinoma, Especially in Node-positive Patients: An Experience from Endemic Region in a Developing Country. Euroasian J Hepatogastroenterol 2021; 11 (1):1-5.

DOI: 10.5005/jp-journals-10018-1336

License: CC BY-NC 4.0

Published Online: 28-06-2021

Copyright Statement:  Copyright © 2021; The Author(s).


Background: Metastasis to lymph nodes is a bad prognostic factor in patients with gallbladder carcinoma who undergo radical cholecystectomy. During the past decade, studies have brought focus on lymph node ratio (LNR) as an additional valuable prognostic factor in these cases. Our research studied the factors that predicted the recurrence of disease and survival of patients with gallbladder carcinoma who were treated with surgical resection, concentrating especially on the lymph nodal status as a prognostic factor and LNR in node-positive T1–T3 cases. Methods: In our hospital, Mahavir Cancer Institute and Research Centre, we reviewed retrospective data, from 2009 to 2014, of 60 patients who had undergone radical cholecystectomy for gallbladder carcinoma. We staged the patients as per the AJCC eight edition. Predictive factors that affect disease-free survival (DFS), like age, gender, postoperative complications, lymphovascular invasion (LVI) and perineural invasion (PVI), lymph node dissection, differentiation, T stage, N stage, number of lymph nodes involved, and LNR, were examined statistically. Results: Lymph nodal involvement was found to be a principal predictive factor in cases in whom radical cholecystectomy was done. The number of lymph nodes dissected determined the prognosis in N0 cases. LNR was a strong prognostic factor for DFS in cases of curatively resected gallbladder cancer. Conclusion: LNR is a strong predictive factor in radically resected gallbladder carcinoma cases.

  1. Justo I, Marcacuzco A, Nutu OA, et al. A retrospective analysis of patients with gallbladder cancer: surgical treatment and survival according to tumor stage. Rev Esp Enferm Dig 2018;110:485–492. DOI: 10.17235/reed.2018.5435/2017.
  2. Shirai Y, Wakai T, Hatakeyama K. Radical lymph node dissection for gallbladder cancer: indications and limitations. Surg Oncol Clin N Am 2007;16(1):221–232. DOI: 10.1016/j.soc.2006.10.011.
  3. Japanese Society of Biliary Surgery. Classification of biliary tract carcinoma. 2nd ed. Tokyo: Kanehara; 2004.4.
  4. Benoist S, Panis Y, Fagniez PL. French University Association for Surgical Research. Long-term results after curative resection for carcinoma of the gallbladder. Am J Surg 1998;175(2):118–122. DOI: 10.1016/s0002-9610(97)00269-9.
  5. Tsukada K, Kurosaki I, Uchida K, et al. Lymph node spread from carcinoma of the gallbladder. Cancer 1997;80:661–667. PMID: 9264348
  6. Endo I, Shimada H, Tanabe M, et al. Prognostic significance of the number of positive lymph nodes in gallbladder cancer. J Gastrointest Surg 2006;10(7):999–1007. DOI: 10.1016/j.gassur.2006.03.006.
  7. Smith DD, Schwarz RR, Schwarz RE. Impact of total lymph node count on staging and survival after gastrectomy for gastric cancer: data from a large US-population database. J Clin Oncol 2005;23(28):7114–7124. DOI: 10.1200/JCO.2005.14.621.
  8. Le Voyer TE, Sigurdson ER, Hanlon AL, et al. Colon cancer survival is associated with increasing number of lymph nodes analyzed: a secondary survey of intergroup trial INT-0089. J Clin Oncol 2003;21(15):2912–2919. DOI: 10.1200/JCO.2003.05.062.
  9. Nitti D, Marchet A, Olivieri M, et al. Ratio between metastatic and examined lymph nodes is an independent prognostic factor after D2 resection for gastric cancer: analysis of a large European monoinstitutional experience. Ann Surg Oncol 2003;10(9):1077–1085. DOI: 10.1245/aso.2003.03.520.
  10. Berger AC, Sigurdson ER, LeVoyer T, et al. Colon cancer survival is associated with decreasing ratio of metastatic to examined lymph nodes. J Clin Oncol 2005;23(34):8706–8712. DOI: 10.1200/JCO.2005.02.8852.
  11. Choi BG, Kim CY, Cho SH, et al. Impact of lymph node ratio as a valuable prognostic factor in gallbladder carcinoma, focusing on stage IIIB gallbladder carcinoma. J Korean Surg Soc 2013;84(3):168–177. DOI: 10.4174/jkss.2013.84.3.168.
  12. Edge SB, Mahul BA, Frederick LG. American Joint Committee on Cancer (AJCC) Staging Handbook: From the AJCC Cancer Staging Manual. 8th ed. Atlanta, GA: American Cancer Society; 2016.
  13. Shimada H, Endo I, Togo S, et al. The role of lymph node dissection in the treatment of gallbladder carcinoma. Cancer 1997;79(5):892–899. DOI: 10.1002/(sici)1097-0142(19970301)79:5<892::aid-cncr4>;2-e.
  14. Yamaguchi K, Chijiiwa K, Saiki S, et al. Retrospective analysis of 70 operations for gallbladder carcinoma. Br J Surg 1997;84(2):200–204.
  15. Miyakawa S, Ishihara S, Horiguchi A, et al. Biliary tract cancer treatment: 5,584 results from the Biliary Tract Cancer Statistics Registry from 1998 to 2004 in Japan. J Hepatobiliary Pancreat Surg 2009;16(1):1–7. DOI: 10.1007/s00534-008-0015-0.
  16. Glenn F, Hays DM. The scope of radical surgery in the treatment of malignant tumors of the extrahepatic biliary tract. Surg Gynecol Obstet 1954;99(5):529–541. PMID: 13205425
  17. Kondo S, Nimura Y, Hayakawa N, et al. Extensive surgery for carcinoma of the gallbladder. Br J Surg 2002;89(2):179–184. DOI: 10.1046/j.0007-1323.2001.02001.x.
  18. Jensen EH, Abraham A, Jarosek S, et al. Lymph node evaluation is associated with improved survival after surgery for early stage gallbladder cancer. Surgery 2009;146(4):706–711. DOI: 10.1016/j.surg.2009.06.056.
  19. Kondo S, Takada T, Miyazaki M, et al. Guidelines for the management of biliary tract and ampullary carcinomas: surgical treatment. J Hepatobiliary Pancreat Surg 2008;15(1):41–54. DOI: 10.1007/s00534-007-1279-5.
  20. Negi SS, Singh A, Chaudhary A. Lymph nodal involvement as prognostic factor in gallbladder cancer: location, count or ratio? J Gastrointest Surg 2011;15(6):1017–1025. DOI: 10.1007/s11605-011-1528-4.
  21. Shirai Y, Sakata J, Wakai T, et al. Assessment of lymph node status in gallbladder cancer: location, number, or ratio of positive nodes. World J Surg Oncol 2012;10:87. DOI: 10.1186/1477-7819-10-87.
  22. Li J, Sun Y, Zhao B, et al. Lymph node ratio-based staging system for gallbladder cancer with fewer than six lymph nodes examined. Front Oncol 2020;10:542005. DOI: 10.3389/fonc.2020.542005.
  23. Bando E, Yonemura Y, Taniguchi K, et al. Outcome of ratio of lymph node metastasis in gastric carcinoma. Ann Surg Oncol 2002;9:775–784. DOI: 10.1007/BF02574500.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.