J Korean Surg Soc.  2013 Mar;84(3):168-177.

Impact of lymph node ratio as a valuable prognostic factor in gallbladder carcinoma, focusing on stage IIIB gallbladder carcinoma

• Choi BG
• Kim CY
• Cho SH
• Kim HJ
• Koh YS
• Kim JC
• Cho CK
• Kim HJ
• Hur YH

Abstract

PURPOSE
It is increasingly being recognized that the lymph node ratio (LNR) is an important prognostic factor for gallbladder carcinoma patients. The present study evaluated predictors of tumor recurrence and survival in a large, mono-institutional cohort of patients who underwent surgical resection for gallbladder carcinoma, focusing specifically on the prognostic value of lymph node (LN) status and of LNR in stage IIIB patients.
METHODS
Between 2004 and 2011, 123 patients who underwent R0 radical resection for gallbladder carcinoma at the Chonnam National University Hwasun Hospital were reviewed retrospectively. Patients were staged according to the American Joint Committee on Cancer 7th edition, and prognostic factors affecting disease free survival, such as age, sex, comorbidity, body mass index, presence of preoperative symptoms, perioperative blood transfusion, postoperative complications, LN dissection, tumor size, differentiation, lymph-vascular invasion, perineural invasion, T stage, presence of LN involvement, N stage, numbers of positive LNs, LNR and implementation of adjuvant chemotherapy, were statistically analyzed.
RESULTS
LN status was an important prognostic factor in patients undergoing curative resection for gallbladder carcinoma. The total number of LNs examined was implicated with prognosis, especially in N0 patients. LNR was a powerful predictor of disease free survival even after controlling for competing risk factors, in curative resected gallbladder cancer patients, and especially in stage IIIB patients.
CONCLUSION
LNR is confirmed as an independent prognostic factor in curative resected gallbladder cancer patients, especially in stage IIIB gallbladder carcinoma.

Keyword

Lymph node ratio; Gallbladder; Carcinoma; Stage IIIB

MeSH Terms

Blood Transfusion
Body Mass Index
Chemotherapy, Adjuvant
Cohort Studies
Comorbidity
Disease-Free Survival
Gallbladder
Gallbladder Neoplasms
Humans
Joints
Lymph Nodes
Postoperative Complications
Prognosis
Recurrence
Retrospective Studies
Risk Factors

Figure

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  Fig. 1 Flow chart detailing surgical management of all the patients with gallbladder cancer.

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  Fig. 2 Kaplan-Meier survival curves according to the presence or absence of regional nodal disease. Five-year disease free survival rate was 80.3% in patients without regional nodal disease, but the median survival time was not reached. The five-year disease free survival rate was 48.5% with a median survival time of 30 months in patients with regional nodal disease (P < 0.001).

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  Fig. 3 Kaplan-Meier survival curves comparing patients in node negative disease with fewer than eight lymph nodes (LNs) examined to those with eight or more LNs examined. All the patients with more than eight LNs examined were not recurred, whereas patients with fewer than eight LNs examined displayed 5-year disease free survival rate of 73.7% (P = 0.087).

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  Fig. 4 Kaplan-Meier survival curves according to the lymph node ratio in patients with stage IIIB gallbladder cancer. Five-year disease free survival rate was 75% in patients with a lymph node ratio (LNR) < 0.5, but the median survival time was not reached. The 5-year disease free survival rate was only 10% with a median survival time of 8.5 months in patients with a LNR > 0.5 (P = 0.003).

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